title: Cost-effectiveness analysis of parenteral antimicrobials for acute melioidosis in Thailand.
abstract: BACKGROUND
  Melioidosis is a common community-acquired infectious disease in northeast Thailand associated with overall mortality of approximately 40% in hospitalized patients, and over 70% in severe cases. Ceftazidime is recommended for parenteral treatment in patients with suspected melioidosis. Meropenem is increasingly used but evidence to support this is lacking.
  
  
  METHODS
  A decision tree was used to estimate the cost-effectiveness of treating non-severe and severe suspected acute melioidosis cases with either ceftazidime or meropenem.
  
  
  RESULTS
  Empirical treatment with meropenem is likely to be cost-effective providing meropenem reduces mortality in severe cases by at least 9% and the proportion with subsequent culture-confirmed melioidosis is over 20%.
  
  
  CONCLUSIONS
  In this context, treatment of severe cases with meropenem is likely to be cost-effective, while the evidence to support the use of meropenem in non-severe suspected melioidosis is not yet available.
authors.affiliation: Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand viriya@tropmedres.ac.
authors.forename: Viriya
authors.initials: V
authors.lastname: Hantrakun
authors.affiliation: Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand.
authors.forename: Wirongrong
authors.initials: W
authors.lastname: Chierakul
authors.affiliation: Melioidosis Research Centre, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen 4002, Thailand.
authors.forename: Ploenchan
authors.initials: P
authors.lastname: Chetchotisakd
authors.affiliation: Melioidosis Research Centre, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen 4002, Thailand.
authors.forename: Siriluck
authors.initials: S
authors.lastname: Anunnatsiri
authors.affiliation: Royal Darwin Hospital and Menzies School of Health Research, Darwin, Northern Territory 0811, Australia.
authors.forename: Bart J
authors.initials: BJ
authors.lastname: Currie
authors.affiliation: Department of Medicine, University of Cambridge, Cambridge, CB2 1TN, UK.
authors.forename: Sharon J
authors.initials: SJ
authors.lastname: Peacock
authors.affiliation: Center for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, OX3 7LE, UK.
authors.forename: Nicholas P J
authors.initials: NP
authors.lastname: Day
authors.affiliation: Center for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, OX3 7LE, UK.
authors.forename: Phaik Yeong
authors.initials: PY
authors.lastname: Cheah
authors.forename: Phaik
authors.initials: P
authors.lastname: Cheah
authors.affiliation: Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand.
authors.forename: Direk
authors.initials: D
authors.lastname: Limmathurotsakul
authors.affiliation: Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand.
authors.forename: Yoel
authors.initials: Y
authors.lastname: Lubell
mesh_terms: D000890:Anti-Infective Agents / Q000191:economics* / Q000627:therapeutic use; D002442:Ceftazidime / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008297:Male; D008554:Melioidosis / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology; D000077731:Meropenem; D013785:Thailand / Q000453:epidemiology; D013845:Thienamycins / Q000191:economics* / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000890:Anti-Infective Agents; D013845:Thienamycins; D002442:Ceftazidime; D000077731:Meropenem
keywords: Antimicrobials; Ceftazidime; Cost-effective treatment; Meliodosis; Meropenem; Northeast Thailand