Economic assessment of doripenem versus imipenem in the treatment of ventilator-associated pneumonia.
BACKGROUND
Ventilator-associated pneumonia (VAP), the most common nosocomial infection in critically ill patients, is associated with significantly longer duration of mechanical ventilation, and increased mortality, hospital days, and health-care costs. A previously published prospective, randomized study established the noninferiority of intravenous (IV) doripenem versus IV imipenem/cilastatin ('imipenem') for VAP. This study compares the economic outcomes of IV therapy with doripenem versus imipenem as first-line treatment for VAP.


METHODS
A decision-analytic model of inpatient care and outcomes for VAP was used to estimate costs associated with VAP treatment. The model calculates total hospital costs, comprising costs of initial and concomitant therapy, and costs associated with mechanical ventilation, intensive care unit stays, and total days in hospital.


RESULTS
Total treatment costs for doripenem were $10,630 lower than for imipenem ($71,259 vs. 81,889), driven primarily by differences in costs of mechanical ventilation ($45,224 for doripenem, $57,348 for imipenem). Probabilistic sensitivity analyses found doripenem consistently cost saving versus imipenem in 1,000 simulations. Study limitations include use of a simple model to represent a complex disease process and reliance on trial data that may not reflect real-world care and outcomes.


CONCLUSIONS
Doripenem is a cost saving first-line treatment for VAP versus imipenem while providing an equivalent rate of cure.
McGarry
Lisa J
LJ
i3 Innovus, 10 Cabot Road, Medford, MA 02155, USA.
Merchant
Sanjay
S
Nathwani
Dilip
D
Pawar
Vivek
V
DeLong
Kelly
K
Thompson
David
D
Akhras
Kasem
K
Ingham
Michael
M
Weinstein
Milton C
MC
D000900:Anti-Bacterial Agents / Q000191:economics* / Q000627:therapeutic use; D015780:Carbapenems / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D000077726:Doripenem; D006760:Hospitalization / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D015378:Imipenem / Q000191:economics* / Q000627:therapeutic use; D007362:Intensive Care Units / Q000191:economics / Q000706:statistics & numerical data; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008875:Middle Aged; D018803:Models, Economic; D009010:Monte Carlo Method; D053717:Pneumonia, Ventilator-Associated / Q000188:drug therapy / Q000191:economics* / Q000401:mortality; D011336:Probability; D012121:Respiration, Artificial / Q000191:economics / Q000706:statistics & numerical data; D013997:Time Factors; D014481:United States
D000900:Anti-Bacterial Agents; D015780:Carbapenems; D015378:Imipenem; D000077726:Doripenem