[Cost-effectiveness analysis of active TDM in elderly patients treated with aminoglycosides].
OBJECTIVE
Aminoglycoside antibiotics use has been limited by the risk of toxicity and their pharmacokinetic variability, thus requiring therapeutic drug monitoring (TDM). As elderly patients are particularly at risk of accumulation, active therapeutic drug monitoring (ATM) can be performed using a Bayesian method. The objective was to analyse the clinical and economic impact of ATM in elderly patients.


METHODS
A two-year retrospective study was performed to compare two geriatric hospitals, one using ATM (SG1) and the other using non-guided TDM (SG2). Efficacy was evaluated by internal reference to target concentration. Direct medical costs were research. Cost-effectiveness results expressed as ratios.


RESULTS
In SG1 56 patients received aminoglycosides and 47 patients in SG2. The cost per patient was 114 € for ATM and 165 € for non-guided TDM. The sensitivity analysis confirmed these results.


CONCLUSIONS
ATM for aminoglycoside is better on three criteria: efficacy, toxicity and cost.
Hospices Civils de Lyon, Groupement Hospitalier de Gériatrie, Service Pharmaceutique, Francheville, France. cecile.burgos-leon@chu-lyon.fr
Cécile Burgos
CB
Leon-Djian
Laurent
L
Bourguignon
Hans-Martin
HM
Späth
Pascal
P
Maire
D000368:Aged; D000369:Aged, 80 and over; D000617:Aminoglycosides / Q000009:adverse effects* / Q000493:pharmacokinetics / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000009:adverse effects* / Q000493:pharmacokinetics / Q000627:therapeutic use; D001424:Bacterial Infections / Q000188:drug therapy; D001499:Bayes Theorem; D003362:Cost-Benefit Analysis; D016903:Drug Monitoring / Q000191:economics*; D064420:Drug-Related Side Effects and Adverse Reactions / Q000191:economics; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies
D000617:Aminoglycosides; D000900:Anti-Bacterial Agents