Economic impact simulation analysis of use of tigecycline, as appropriate, in first-course antibiotic therapy for complicated intra-abdominal infections in intensive care patients.
OBJECTIVE
Tigecycline is a broad spectrum antibiotic indicated by official and health ministry guidelines for use in second course therapy for complicated intra-abdominal infections (cIAI). In certain objective and subjective circumstances, however, its use in first-line therapy may be appropriate. Without entering into a detailed evaluation of use appropriateness, the aim of this study was to determine the economic impact on hospital budget expenditure for two different prescribing practices: use of tigecycline in second or first-line therapy. This empirical study was carried out at the Intensive Care Unit (ICU) (chief, Dr. Alberto Costantini), Ospedali Riuniti, Ancona.


METHODS
Cost determination was based on health care processes as revealed by field survey at the ICU. Mapping of the health care processes was not derived from official protocols or from an ex post analysis of medical records but rather directly from descriptions of the processes as referred by the ICU physicians and health care staff, and then summarized in flow charts and approved by the ICU chief.


RESULTS
The assumption was that tigecycline, because it has a broader spectrum of action than a first-line antibiotic, would more probably clear infections when used in the first course of antibiotic therapy. Notwithstanding this advantage, tigecycline has a higher daily dose cost than first-line antibiotics. This study compared the higher costs incurred by the use of tigecycline as a first-line antibiotic versus potential savings obtained with such use, also in view of the prevention of possible treatment failures and the additional cost of administering a second course of antibiotic therapy, wherein the result would depend on the number of preventable treatment failures.


CONCLUSIONS
The analysis concludes with a discussion and graphic illustrations comparing the differential probable treatment success which would render the two treatment alternatives economically indifferent.
Partner PricewaterhouseCoopers Advisory SpA, Industry Pharma, Milan, Italy. franco.ancona@it.pwc.com
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Ancona
D000900:Anti-Bacterial Agents / Q000191:economics* / Q000627:therapeutic use; D001424:Bacterial Infections / Q000150:complications / Q000188:drug therapy / Q000191:economics*; D002985:Clinical Protocols; D003362:Cost-Benefit Analysis; D003422:Critical Care; D016527:Drug Costs; D017721:Hospital Costs; D006801:Humans; D007362:Intensive Care Units / Q000191:economics*; D007902:Length of Stay / Q000191:economics; D008911:Minocycline / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D019233:Retreatment / Q000191:economics; D000078304:Tigecycline; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D000078304:Tigecycline; D008911:Minocycline