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Medicine: Evidence-Based Research: Plenary Session
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Abstract This session will present new evidence-based data from recently performed clinical trails to be chosen before the meeting. (Presentation 23.2) The economic advantages of a once-daily parenteral antibiotic: a cost analysis of the SIDESTEP study Alan Tice, Robin Turpin, Jasmanda Wu, Stephanie Taylor, Adam Polis, Murray Abramson Diabetic foot infections (DFI) account for more hospital days than any diabetes-related diagnosis. Many patients with DFI are Medicare-eligible, and hospitals are motivated to decrease costs without altering patient outcomes. A large, multicenter, randomized, double-blind trial (SIDESTEP) comparing ertapenem (1 g/QD) and piperacillin/tazobactam (3.375 g/QID) found equivalent efficacy in the treatment of DFI. We performed a hospital-based cost comparison using SIDESTEP data to identify differences in drug, labor, and supplies in the preparation and administration of ertapenem versus piperacillin/tazobactam. Individuals enrolled in SIDESTEP, treated entirely as inpatients, and clinically evaluable at final assessment (10 days after completing antibiotic therapy; n = 99) were included. Cost per dose was calculated from (a) average actual hospital acquisition price/dose* for 2005 in US dollars for ertapenem ($40.52) or piperacillin/tazobactam ($13.58); (b) average US wage and benefits for labor, based a review of 9 time-and-motion studies of intravenous antibiotic drug preparation and administration ($3.03); and (c) consumable supplies, using a 40% discount off manufacturer list price in the 2005 Redbook ($2.52). For each patient, actual doses (either ertapenem or piperacillin/tazobactam) was multiplied by total cost per dose (ertapenem = $45.23; piperacillin/tazobactam = $19.13). No differences with respect to demographics, mean length of treatment or wound severity were noted (intravenous therapy days: ertapenem = 6.6; piperacillin/tazobactam = 6.4); (wound severity: ertapenem = 29%; piperacillin/tazobactam = 26% severe). Differences were significant with respect to mean doses of active drug (ertapenem = 7.6; piperacillin/tazobactam = 25.7; P < 0.0001) and costs (ertapenem = $352.64; piperacillin/tazobactam = $493.00; P = 0.018). The $140.36 difference between groups accounts for approximately 3% of total hospital DRG reimbursements for Medicare patients. Once-daily dosing of ertapenem offers the advantage of less cost to hospitals, compared to QID dosing for piperacillin/tazobactam, without compromising efficacy or safety. *IMS Health, National Sales Perspectives™ References Lipsky BA, Armstrong DG, Citron DM, Tice AD, Morgenstern DE, Abramson MA. Ertapenem versus piperacillin/tazobactam for diabetic foot infections (SIDESTEP): prospective, randomized, controlled, double-blinded, multicentre trial. Lancet. 2005;366:1695–1703. Drug acquistion cost data provided by IMS Health, National Sales Perspectives™ |
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