Costo económico marginal del fracaso terapéutico con ampicilina más amikacina en el tratamiento de la sepsis neonatal temprana / Cost of therapeutic failure of ampicillin plus amikacin in the treatment of early neonatal sepsis

Objetivo: Evaluar el costo marginal de la falla terapéutica del esquema antimicrobiano ampicilina más amikacina en el tratamiento de sepsis neonatal temprana. Métodos: Un total de 86 de 121 recién nacidos menores de 72h de vida, estudiados entre 2001 y 2005 en la unidad de cuidados intensivos neonatales con sospecha de sepsis neonatal se consideraron con fracaso terapéutico cuando se administró tratamiento con ampicilina más amikacina como primera opción. En todos ellos se trató con vancomicina o cefotaxima como segundo esquema de tratamiento. Se utilizó el método contable o directo para abordar el análisis de costos, en particular el enfoque del gasto por actividades, y se identificaron los gastos ejercidos en el tratamiento de estos 86 pacientes. Resultados: Los costos por medicamentos, por hospitalización, por insumos y por honorarios del personal son mayores al utilizar vancomicina o cefotaxima (350,924 dólares o 275,116 euros) que los gastos que se realizan al utilizar ampicilina más amikacina (159,251 dólares o 124,878 euros). Sin embargo, este último gasto no representa beneficio alguno para el paciente ni para la institución. Resultados: Al compararlos como factores que favorecen la curación clínica se encuentra lo siguiente: ampicilina más amikacina (riesgo relativo [RR] de 1,09, intervalo de confianza [IC] del 95%: 0,39 a 2,1; p=0,8) frente a cefotaxima o vancomicina (RR de 0,02, IC del 95%: 0,04 a 0,32; p<0,05). Conclusiones: Aunque de inicio el costo es mayor con el uso de vancomicina o cefotaxima, el ahorro al dejar de utilizar un esquema poco eficaz, como ampicilina más amikacina, supera el gasto que se realiza al utilizar un esquema de rescate (AU)

Objective: To evaluate the marginal cost of therapeutic failure with Ampicillin/amikacin as the first-line antibiotic treatment of early-onset neonatal sepsis (ENS). Methods: Out of a total of 121 newborns, 86 failed to respond to Ampicillin/amikacin when it was used as first-line treatment within their first 72h of life. All of them were admitted to the NICU between 2001 and 2005 with suspicion of sepsis. After this failure to respond, vancomycin and/or cefotaxime were used as the second treatment option for these newborns. Using a full cost method we performed a cost analysis with an activity-based-costing (ABC) perspective, identifying the costs generated by these 86 patients. Results: The costs comprising medication, hospitalization, supplies and clinical staff salaries were higher when vancomycin and/or cefotaxime were used (350,924 dollars or 275,116 euros) compared to those generated with an Ampicillin/amikacin regimen (159,251 dollars or 124,878 euros).ResultsWhen compared as protective factors, the relative risk was 1.09 (95% CI; 0.39 2.1 P=0.8) for Ampicillin/amikacin vs. 0.02 (95% CI; 0.04 0.32 P<0.05) for vancomycin and/or cefotaxime. Conclusions: Even though vancomycin and/or cefotaxime are initially more costly, there is a cost saving derived from the use of this antibiotic treatment as the first-line therapeutic option instead of as a rescue therapy when a lower-efficacy regimen (Ampicillin/amikacin) has failed (AU)

[Cost of therapeutic failure of ampicillin plus amikacin in the treatment of early neonatal sepsis]. / Costo económico marginal del fracaso terapéutico con ampicilina más amikacina en el tratamiento de la sepsis neonatal temprana.

OBJECTIVE: To evaluate the marginal cost of therapeutic failure with Ampicillin/amikacin as the first-line antibiotic treatment of early-onset neonatal sepsis (ENS). METHODS: Out of a total of 121 newborns, 86 failed to respond to Ampicillin/amikacin when it was used as first-line treatment within their first 72h of life. All of them were admitted to the NICU between 2001 and 2005 with suspicion of sepsis. After this failure to respond, vancomycin and/or cefotaxime were used as the second treatment option for these newborns. Using a full cost method we performed a cost analysis with an activity-based-costing (ABC) perspective, identifying the costs generated by these 86 patients. RESULTS: The costs comprising medication, hospitalization, supplies and clinical staff salaries were higher when vancomycin and/or cefotaxime were used (350,924 dollars or 275,116 euros) compared to those generated with an Ampicillin/amikacin regimen (159,251 dollars or 124,878 euros). When compared as protective factors, the relative risk was 1.09 (95% CI; 0.39-2.1 P=0.8) for Ampicillin/amikacin vs. 0.02 (95% CI; 0.04-0.32 P<0.05) for vancomycin and/or cefotaxime. CONCLUSIONS: Even though vancomycin and/or cefotaxime are initially more costly, there is a cost saving derived from the use of this antibiotic treatment as the first-line therapeutic option instead of as a rescue therapy when a lower-efficacy regimen (Ampicillin/amikacin) has failed.