title: Cost effectiveness of three drugs for the treatment of S.               aureus infections in Nigeria.
abstract: BACKGROUND
  Resistance of microorganisms to existing antimicrobial agents threatens the effective utilization of available resources in sub-Saharan Africa. Cost-effective utilization of antibacterial agents is essential in effective health care delivery in Nigeria.
  
  
  OBJECTIVE
  To determine the most cost effective antibacterial agent in the treatment of S. aureus infections in Lagos metropolis.
  
  
  METHODS
  The study was carried out in a teaching hospital, a specialist hospital, a referral center and two private hospitals.
  
  
  METHODS
  Cost effectiveness analysis of ciprofloxacin, cefuroxime and gentamicin identified to be most effective agent against 463 clinical isolates of S. aureus obtained from the five hospitals was carried out on the basis of societal, health care and third party perspectives using 'decision table" as an analytical model. Criteria considered in the model included degree of efficacy of the agents, adherence tendencies and tolerability. Both direct (cost of drugs, diagnosis/monitoring, personnel and transportation) and indirect (loss of productivity) costs were evaluated.
  
  
  METHODS
  These include economic outcome as total therapy cost, clinical outcomes as extent of antibacterial effectiveness obtained from degree of antibacterial efficacy, a proxy measurement of cure rates, and adherence tendency. Humanistic outcome was also measured as tolerability prorated from literature reported degree of adverse drug reactions events, risk of infection and pains from drug administration.
  
  
  RESULTS
  Ciprofloxacin tablet is a dominant option and much more cost-effective than either cefuroxime or gentamicin in the treatment of S. aureus in Lagos. Regardless of the perspective of analysis, ciprofloxacin has the least cost effectiveness ratio of NGN4214.66 ($28.09), NGN2392.63 ($16.00) and NGN2048.66 ($13.65) from societal, health care and third party payer perspectives, respectively. Sensitivity analysis by increasing the effectiveness index of gentamicin injection-the least cost effective option to the value for the most cost effective option did not change the results.
  
  
  CONCLUSIONS
  Ciprofloxacin should be used as first-line-treatment of S aureus in Lagos as it will lead to significant cost savings in the treatment of S. aureus infections.
authors: Department of Clinical Pharmacy and Biopharmacy, Faculty of Pharmacy, University of Lagos, College of Medicine Campus, Idi-Araba, PMB 12003, Lagos, Surulere, Nigeria. suleimanismail1@gmail.com
authors: Ismail Ayinla
authors: IA
authors: Suleiman
authors: Babajide Solomon
authors: BS
authors: Bamiro
authors: Fola
authors: F
authors: Tayo
mesh_terms: D000900:Anti-Bacterial Agents / Q000191:economics / Q000627:therapeutic use; D002444:Cefuroxime / Q000191:economics* / Q000627:therapeutic use; D002939:Ciprofloxacin / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis / Q000191:economics / Q000379:methods; D005839:Gentamicins / Q000191:economics* / Q000627:therapeutic use; D006801:Humans; D009549:Nigeria / Q000453:epidemiology; D011446:Prospective Studies; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000191:economics* / Q000453:epidemiology*; D013211:Staphylococcus aureus
chemical_list: D000900:Anti-Bacterial Agents; D005839:Gentamicins; D002939:Ciprofloxacin; D002444:Cefuroxime