title: Cost-minimization analysis of imipenem/cilastatin versus meropenem in moderate to severe infections at a tertiary care hospital in Saudi Arabia.
abstract: OBJECTIVE
  The aim of this study was to compare the costs of management of moderate to severe infections in patients treated with imipenem/cilastatin (IC) and meropenem (MEM). Pharmacoeconomic studies in Saudi Arabia are scarce. The current hospital formulary contains 2 carbapenems: IC and MEM. These antibiotics share a similar spectrum of activity. There are conflicting reviews with regard to the relative cost-effectiveness of these two agents.
  
  
  METHODS
  A retrospective, single-centre cohort study of 88 patients of IC versus MEM in moderate to severe infections was performed, applying cost-minimization analysis (CMA) methods. In accordance with CMA methods, the assumption of equivalent efficacy was first demonstrated by literature retrieved and appraised. Adult patients (⩾18 years old) diagnosed with moderate to severe infections, including skin and skin structure infections (SSIs), sepsis, intra-abdominal infections (IAIs), respiratory tract infections, urinary tract infections (UTIs) and hospital-acquired infections (HAIs), who were prescribed IC 500 mg every six hours intravenously (2 g per day) or MEM 1 g every eight hours (3 g per day), were included in the study. Only direct costs related to the management of the infections were included, in accordance with a payer perspective.
  
  
  RESULTS
  Overall there was no difference in the mean total daily costs between IC (SAR 4784.46, 95% CI 4140.68, 5428.24) and MEM (4390.14, 95% CI 3785.82, 4994.45; p = 0.37). A significantly lower medicine acquisition cost per vial of IC was observed when compared to MEM, however there was a significantly higher cost attached to administration sets used in the IC group than the MEM group. Consultation, nursing and physician costs were not significantly different between the groups. No differences were observed in costs associated with adverse drug events (ADEs).
  
  
  CONCLUSIONS
  This study has shown that while acquisition costs of IC at a dose of 500 mg q6 h may be lower than for MEM 1 g q8 h, mean total costs per day were not significantly different between IC and MEM, indicating that medicine costs are only a small element of the overall costs of managing moderate to severe infections.
authors.affiliation: Department of Pharmaceutical Care, PO Box 40740, Prince Muhammed bin Abdulaziz Hospital, Ministry of National Guard Health Affairs, Al-Madina Al-Monowarrah, Saudi Arabia.
authors.forename: Imraan
authors.initials: I
authors.lastname: Joosub
authors.affiliation: Division of Pharmacology, Discipline of Pharmaceutical Sciences, University of KwaZulu-Natal, Durban, South Africa.
authors.forename: Andy
authors.initials: A
authors.lastname: Gray
authors.affiliation: Department of Pharmaceutical Care, PO Box 2477, Al-Hasa, 31982, King Abdulaziz Hospital, Al-Ahsa, Ministry of National Guard Health Affairs, Saudi Arabia.
authors.forename: Analyn
authors.initials: A
authors.lastname: Crisostomo
authors.affiliation: King Abdullah International Medical Research Center-Eastern Region (KAIMRC-ER), Ministry of National Guard Health Affairs, PO Box 2477, Al-Hasa 31982, Saudi Arabia.
authors.forename: Abdul
authors.initials: A
authors.lastname: Salam
keywords: Antibiotics; Antimicrobial therapy; Carbapenems; Cost-minimization analysis; Imipenem; Meropenem; Moderate to severe infections; Pharmacoeconomics; Saudi Arabia