title: Estimation of the clinical and economic consequences of non-compliance with antimicrobial treatment of canine skin infections.
abstract: The goal of this study was to estimate the health and economic consequences of non-compliance with oral antimicrobial treatment in dogs with superficial pyoderma, wounds or abscesses in the US. A mathematical model (Markov model) which simulated treatment with long-term injectable cefovecin versus oral amoxicillin/clavulanic acid was developed and accounted for the effect of non-compliance on clinical outcomes and mean total treatment costs per patient. Efficacy parameters considered in the model were derived from clinical studies. Treatment failure due to oral antimicrobial treatment non-compliance was approximated from published data at 13.6%. US cost data for 2009 were derived from public sources. When non-compliance was considered as a cause of treatment failure with oral medication, the long-term injectable antibiotic was more effective than oral comparator (162 versus 158 days without clinical signs). Mean total treatment costs were lower with cefovecin (USD 376.74) versus amoxicillin/clavulanic acid (USD 382.34) in dogs of 25 kg; and cefovecin remained cost-saving up to a body weight of 31 kg. In large dogs, cefovecin was more costly; however, total therapy costs were less than 6% greater than with amoxicillin/clavulanic acid. Accordingly the higher drug and administration costs of the long-term injectable antibiotic were totally or substantially offset when non-compliance was considered as reason for treatment failure with oral medication. The model also allowed for the estimation of the impact of various non-compliance scenarios.
authors.affiliation: Deloitte Consulting CVBA, Berkenlaan 8c, B-1831 Diegem, Belgium. ivanvlaenderen@chessinhealth.com
authors.forename: Ilse
authors.initials: I
authors.lastname: Van Vlaenderen
authors.forename: Barbara Poulsen
authors.initials: BP
authors.lastname: Nautrup
authors.forename: Sabina M
authors.initials: SM
authors.lastname: Gasper
mesh_terms: D000038:Abscess / Q000188:drug therapy / Q000662:veterinary*; D000284:Administration, Oral; D000658:Amoxicillin / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D000818:Animals; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D019818:Clavulanic Acid / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D004283:Dog Diseases / Q000188:drug therapy*; D004285:Dogs; D005260:Female; D007279:Injections, Subcutaneous / Q000662:veterinary; D008297:Male; D008390:Markov Chains; D010349:Patient Compliance; D011711:Pyoderma / Q000188:drug therapy / Q000662:veterinary*; D016896:Treatment Outcome; D014946:Wound Infection / Q000188:drug therapy / Q000662:veterinary*
chemical_list: D000900:Anti-Bacterial Agents; D019818:Clavulanic Acid; D000658:Amoxicillin