title: Impact of a Dynamic Microbiological Environment on the Clinical Efficacy of Ertapenem and Piperacillin/Tazobactam in the Treatment of Complicated Community-Acquired Intra-Abdominal Infection in Spain: A Cost-Consequence Analysis.
abstract: OBJECTIVE
  The microbial susceptibility of many antibiotics has been affected by prescribing patterns and their extensive use. The purpose of this evaluation was to assess how these changes could affect the initial efficacy of ertapenem and piperacillin/tazobactam in the treatment of complicated intra-abdominal infections (IAIs) acquired in the community and the potential consequences this may have in healthcare costs in Spain.
  
  
  METHODS
  The Initial efficacy of ertapenem and piperacillin/tazobactam for patients with APACHE (Acute Physiology and Chronic Health Evaluation) II scores <10 was extracted from a multicenter randomized study and were combined with the current microbial susceptibilities obtained from the SMART study, a multinational surveillance program. Country-specific pathogens distribution was extracted from a national study in patients with community-acquired IAI. The estimated effectiveness was used in a decision-analytic model to compare total costs between ertapenem and piperacillin/tazobactam in the treatment of complicated IAI. The model performs extensive one-way and probabilistic sensitivity analyses.
  
  
  RESULTS
  The model suggested a savings of €209 (year 2012 values) per patient when complicated IAIs acquired in the community (APACHE II <10) were treated with ertapenem instead of piperacillin/tazobactam. One-way sensitivity analyses showed length of stay as the key driver parameter. Further analysis of this parameter and probabilistic sensitivity analysis confirmed the robustness of our evaluation, with a 58% likelihood of ertapenem being dominant.
  
  
  CONCLUSIONS
  Ertapenem appears to be a cost-saving strategy over piperacillin/tazobactam for the treatment of patients with complicated IAIs acquired in the community in Spain.
authors.affiliation: Hospital del Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain, sgrau@parcdesalutmar.cat.
authors.forename: Santiago
authors.initials: S
authors.lastname: Grau
authors.forename: Virginia
authors.initials: V
authors.lastname: Lozano
authors.forename: Amparo
authors.initials: A
authors.lastname: Valladares
authors.forename: Rafael
authors.initials: R
authors.lastname: Cavanillas
authors.forename: Yang
authors.initials: Y
authors.lastname: Xie
authors.forename: Gonzalo
authors.initials: G
authors.lastname: Nocea
mesh_terms: D018806:APACHE; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D017326:Clinical Trials, Phase III as Topic / Q000706:statistics & numerical data; D017714:Community-Acquired Infections / Q000188:drug therapy* / Q000191:economics / Q000382:microbiology; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D004311:Double-Blind Method; D024901:Drug Resistance, Multiple, Bacterial / Q000187:drug effects*; D004359:Drug Therapy, Combination; D000077727:Ertapenem; D006801:Humans; D059413:Intraabdominal Infections / Q000188:drug therapy* / Q000191:economics / Q000382:microbiology; D007902:Length of Stay / Q000191:economics; D018803:Models, Economic; D009010:Monte Carlo Method; D015337:Multicenter Studies as Topic / Q000706:statistics & numerical data; D010397:Penicillanic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D010878:Piperacillin / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D000077725:Piperacillin, Tazobactam Drug Combination; D013030:Spain; D047090:beta-Lactams / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*
chemical_list: D000900:Anti-Bacterial Agents; D047090:beta-Lactams; D000077725:Piperacillin, Tazobactam Drug Combination; D010397:Penicillanic Acid; D000077727:Ertapenem; D010878:Piperacillin