ABSTRACT
BACKGROUND: A series of 459 hospitalized adults with complicated intra-abdominal infections participated in a randomized, double-blind, multicenter clinical trial. The present study was conducted to add a pharmacoeconomic analysis to the results. METHODS: A cost-effectiveness analysis from the perspective of the hospital provider was carried out. Decision analysis was used to illustrate outcomes and to provide a basis on which to conduct a sensitivity analysis. Cost-effectiveness ratios, representing the cost per expected successfully treated patient, were calculated to determine the most cost-effective alternative. RESULTS: Among 244 economically evaluable patients, enrolled from 34 centers in the U.S. and Canada, 131 patients received ciprofloxacin-metronidazole (75% clinical success rate), and 113 received piperacillin-tazobactam (65% clinical success rate; p = 0.06). Switch to oral antibiotics was possible for 81 patients who received ciprofloxacin-metronidazole (85% clinical success rate) and 67 piperacillin-tazobactam patients (70% clinical success rate; p = 0.027). The mean hospital cost was US$10,662 +/- 7,793 for patients in the ciprofloxacin-metronidazole group and $10,009 +/- 7,023 for patients in the piperacillin-tazobactam group (p = 0.492). Significantly lower costs were documented for patients who could be switched to oral antibiotics than for those continued on intravenous antibiotic orders ($8,684 +/- 4,120 vs. $12,945 +/- 10,204, respectively; p < 0.001). Patients with appendicitis had lower mean hospital costs than those with other infections ($7,169 +/- 3,705 vs. $12,097 +/- 8,342, respectively; p < 0.001). The cost-effectiveness ratios were $14,216:1 for patients in the ciprofloxacin-metronidazole group and $15,398:1 for patients in the piperacillin-tazobactam group. CONCLUSIONS: The mean hospital costs associated with ciprofloxacin-metronidazole were similar to those of piperacillin-tazobactam for the treatment of adults with complicated intra-abdominal infections. Lower costs were documented for patients able to be switched to oral antibiotics and for patients with appendicitis.
Subject(s)
Abdominal Abscess/drug therapy , Anti-Bacterial Agents , Appendicitis/drug therapy , Ciprofloxacin , Metronidazole , Peritonitis/drug therapy , Abdominal Abscess/complications , Abdominal Abscess/microbiology , Adult , Aged , Anti-Bacterial Agents/administration & dosage , Anti-Bacterial Agents/economics , Anti-Bacterial Agents/therapeutic use , Appendicitis/complications , Appendicitis/microbiology , Ciprofloxacin/administration & dosage , Ciprofloxacin/economics , Ciprofloxacin/therapeutic use , Cost-Benefit Analysis , Double-Blind Method , Drug Therapy, Combination , Economics, Pharmaceutical , Female , Humans , Male , Metronidazole/administration & dosage , Metronidazole/economics , Metronidazole/therapeutic use , Middle Aged , Penicillanic Acid/administration & dosage , Penicillanic Acid/analogs & derivatives , Penicillanic Acid/economics , Penicillanic Acid/therapeutic use , Peritonitis/complications , Peritonitis/microbiology , Piperacillin/administration & dosage , Piperacillin/economics , Piperacillin/therapeutic use , Piperacillin, Tazobactam Drug Combination , Treatment OutcomeABSTRACT
Chronic glucocorticoid therapy is prescribed in renal transplant recipients according to empiric dose-tapering schedules, which assume a similar pharmacologic response in men and women. The study objectives were (a) to compare the pharmacokinetics of methylprednisolone in premenopausal renal transplant recipients with previously studied male counterparts and (b) to describe the pharmacodynamic response of the hypothalamic-pituitary-adrenal axis during chronic steroid therapy. Thirteen stable premenopausal subjects (ages 30 to
