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PharmacoEconomics
Published in: PharmacoEconomics 1/2001

01-01-2001 | Original Research Article

Cost Efficacy of Tazobactam/Piperacillin versus Imipenem/Cilastatin in the Treatment of Intra-Abdominal Infection

Authors: Dr Eva Susanne Dietrich, Björn Schubert, Winfried Ebner, Franz Daschner

Published in: PharmacoEconomics | Issue 1/2001

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Abstract

Objective: To compare the cost, efficacy and cost efficacy of tazobactam/piperacillin and imipenem/cilastatin in the treatment of intra-abdominal infection.
Design: The analysis was retrospective and based on a decision tree. Effectiveness data were obtained from 19 published clinical trials. Direct costs were quantified per patient from the time the decision was made to administer the antibacterial to the end of the first course of treatment or the end of a subsequent course of treatment, if required. The primary end-pointwas the cost per successfully treated patient. The cost per life saved was also analysed. Various follow-up times were taken into account.
Perspective: German National Health Insurance funds.
Study population: 1744 patients with intra-abdominal infection.
Interventions: Tazobactam/piperacillin (total daily dosage of 13.5 g/day) and imipenem/cilastatin (total daily dosage of 1.5 to 4 g/day). The mean duration of treatment varied from 5.5 to 8.2 days for tazobactam/piperacillin and 5 to 9.4 days for imipenem/cilastatin.
Main outcome measure and results: Compared with imipenem/cilastatin, treatment with tazobactam/piperacillin was more effective and the overall treatment costs were lower. In the base-case analysis, the cost-efficacy ratio (cost per successfully treated patient) was 7881 German deutschmarks (DM) for tazobactam/piperacillin and DM11 390 for imipenem/cilastatin. The incremental cost-efficacy ratio (per life saved) varied between -DM72 567 and -DM350 738 for tazobactam/piperacillin. Sensitivity analyses revealed that the results were robust against various assumptions on cost parameters, clinical outcomes and length of treatment. All costs reflect 1998 values; $US1 = DM1.85.
Conclusions: This study suggests that compared with imipenem/cilastatin, tazobactam/piperacillin is more cost efficacious in the treatment of intra-abdominal infections and that it offers a cost advantage through fewer relapses and lower daily therapeutic costs.
Literature
1.
Kirschner M. Die behandlung der akuten eitrigen freien bauchfellentzuendung. Langenbecks Arch Klin Chir 1926; 142: 53
2.
Meakins JL, Solomkin JS, Allo MD, et al. A proposed classification of intra-abdominal infections. Arch Surg 1984; 119: 1372–8PubMedCrossRef
3.
4.
Levison ME, Bush LM. Peritonitis and other intra-abdominal infections. In: Mandell GL, Benett JE, Dolin R, editors. Principles and practice of infectious diseases. New York (NY): Churchill Livingstone, 1990: 636–70
5.
Wilson SE. Carbapenem: monotherapy in intra-abdominal sepsis. Scand J Infect Dis 1995; Suppl.: 96: 28–33
6.
Condon RE, Walker AP, Sirinek KR, et al. Meropenem versus tobramycin versus clindamycin for treatment of intra-abdominal infections: results of a prospective, randomized, double-blind clinical trial. Clin Infect Dis 1995; 21: 544–50PubMedCrossRef
7.
Balfour JA, Bryson HM, Brogden RN. Imipenem/cilastatin. An update of its antibacterial activity, pharmacokinetics and therapeutic efficacy in the treatment of serious infections. Drugs 1996; 51 (1): 99–136PubMedCrossRef
8.
Bryson HM, Brogden RN. Piperacillin/tazobactam: a review of its antibacterial activity, pharmacokinetic properties and therapeutic potential. Drugs 1994; 47 (3): 506–35PubMedCrossRef
9.
Vogel F, Naber KG, Wacha H, and the Expert Group of the Paul-Ehrlich-Society for Chemotherapy, et al. Parenterale antibiotika bei erwachsenen. Chemotherapie J 1999; 1: 3–49
10.
Johnson CC, Baldessare J, Levinson ME. Peritonitis: update on pathophysiology, clinical manifestations, and management. Clin Infect Dis 1997; 24: 1035–47PubMedCrossRef
11.
Wittmann DH, Schein M, Condon RE. Management of secondary peritonitis. Ann Surg 1996; 222: 10–8CrossRef
12.
Focht J, Nösner K. Empfindlichkeitsspektrum von ceftriaxon und anderen antibiotika. Krankenhauspharmazie 1997; 11: 531–4
13.
Jaccard C, Troillet N, Harbarth S, et al. Prospective randomized comparison of imipenem-cilastatin and piperacillin-tazobactam in nosocomial pneumonia or peritonitis. Antimicrob Agents Chemother 1998; 42: 2966–72PubMed
14.
Niinikoski J, Tapani H, Alhava E, et al. Piperacillin/tazobactam versus imipenem/cilastatin in the treatment of intra-abdominal infections. Surg Gynecol Obstet 1993; 176: 255–61PubMed
15.
Eklund AE, Nord CE, Brismar B, et al. A randomized multicenter trial of piperacillin/tazobactam versus imipenem/cilastatin in the treatment of severe intra-abdominal infections. J Antimicrob Chemother 1993; 31 Suppl. A: 79–85PubMedCrossRef
16.
Jhee SS, Gill MA, Yellin AE, et al. Pharmakooekonomische untersuchung zum vergleich von piperacillin/tazobactam und imipenem/cilastatin bei der behandlung von patienten mit intra-abdominellen infektionen. Clin Ther 1995; 17: 126–35PubMedCrossRef
17.
Jones RN. Clinical use of β-lactamase inhibitors in combination with extended-spectrum penicillins. Am J Health Syst Pharm 1995; 52 Suppl. 2: 29–33
18.
Sanders WE, Sanders CC. Piperacillin/tazobactam: a critical review of the evolving clinical literature. Clin Infect Dis 1996; 22: 107–23PubMedCrossRef
19.
Schoonover LL, Occhipinti DJ, Rodvold KA, et al. Piperacillin/tazobactam: a new beta-lactam/beta-lactamase inhibitor combination. Ann Pharmacother 1995; 29: 501–13PubMed
20.
Calandra GB, Wang C, Aziz M, et al. The safety profile of imipenem/cilastatin: worldwide clinical experience based on 3470 patients. J Antimicrob Chemother 1986; 18 Suppl. E: 193–202PubMed
21.
Kuye O, Teal J, DeVries VG, et al. Safety profile of piperacillin/tazobactam in phase I and III clinical studies. J Antimicrob Chemother 1993; 31 Suppl. A: 113–24PubMedCrossRef
22.
de Lissovoy G, Elixhauser A, Luce BR, et al. Cost analysis of imipenem/cilastatin versus clindamycin with tobramycin in the treatment of acute intra-abdominal infection. Pharmacoeconomics 1993; 4 (3): 203–14PubMedCrossRef
23.
Rodloff AC, Kujath P, Lünstedt B, et al. Vergleichende untersuchung zum kosten-/effektivitaetsverhaeltnis einer initialen therapie mit imipenem/cilastatin bei der sekundaeren peritonitis. Chirurg 1998; 69: 10933–1100CrossRef
24.
Norrby SR, Eriksson M, Ottosson E. Imipenem/cilastatin versus gentamicin/clindamycin: a cost effectiveness study. Scand J Infect Dis 1986; 18 (4): 371–4PubMedCrossRef
25.
Bohnen JMA, Solomkin JS, Dellinger EP, et al. Guidelines for clinical care: anti-infective agents for intra-abdominal infections. Arch Surg 1992; 127: 83–9PubMedCrossRef
26.
Stewart LA, Clarke MJ. Practical methodology of meta-analyses using updated individual patient data. Stat Med 1995; 14: 2057–79PubMedCrossRef
27.
The University of York. NHS Centre for Reviews and Dissemination (1996 Jan). Undertaking systematic reviews of research on effectiveness. CRD guidelines for those carrying out or commissioning reviews. CRD report no. 4 [online]. Available from: URL: http://​www.​york.​ac.​uk/​inst/​crd/​report4.​htm [Accessed 2000 Nov 29]
28.
29.
Haselkorn JK, Turner JA, Diehr PK, et al. Literature review. A useful tool for the spine researcher. Spine 1994; 19 Suppl. 18: 2076S–82SPubMedCrossRef
30.
Cakmakci M, Stern A, Schilling J, et al. Randomized comparative trial of imipenem/cilastatin versus aminoglycoside plus amoxycillin plus clindamycin in the treatment of severe intra- and post-operative infections. Drugs Exp Clin Res 1993; 19: 223–7PubMed
31.
Colardyn F, Faulkner KL, Byl B, et al. Intravenous meropenem versus imipenem/cilastatin in the treatment of serious bacterial infections in hospitalized patients. J Antimicrob Chemother 1996; 38: 523–37PubMedCrossRef
32.
Garau J, Blanquer J, Cobo L, et al. Prospective, randomised, multicentre study of meropenem versus imipenem/cilastatin as empiric monotherapy in severe nosocomial infections. Eur J Clin Microbiol Infect Dis 1997; 16: 789–96PubMedCrossRef
33.
Anwar N, Merchant M, Were T, et al. Prospective, randomized study of the comparative safety and efficacy of intraperitoneal imipenem versus vancomycin and netilmicin in the treatment of peritonitis on CAPD Perit Dial Int 1995; 15: 167–71PubMed
34.
Brismar B, Malmborg AS, Tunevall G, et al. Piperacillin-tazobactam versus imipenem-cilastatin for treatment of intra-abdominal infections. Antimicrob Agents Chemother 1992; 36: 2766–73PubMedCrossRef
35.
Barie PS, Vogel SB, Dellinger EP, et al. A randomized, double-blind clinical trial comparing cefepime plus metronidazole with imipenem-cilastatin in the treatment of complicated intra-abdominal infections. Cefepine Intra-Abdominal Infection Study Group. Arch Surg 1997; 132 (12): 1294–302PubMedCrossRef
36.
Basoli A, Meli EZ, Mazzocchi P, et al. Imipenem/cilastatin (1.5 g daily) versus meropenem (3.0 g daily) in patient with intra-abdominal infections: results of a prospective, randomized, multicentre trial. Scand J Infect Dis 1997; 29 (5): 503–8PubMedCrossRef
37.
Brismar B, Malmborg AS, Tunevall G, et al. Meropenem versus imipenem/cilastatin in the treatment of intra-abdominal infections. J Antimicrob Chemother 1995; 35: 139–48PubMedCrossRef
38.
Brismar B, Akerlund J-E, Sjöstedt S, et al. Biapenem versus imipenem/cilastatin in the treatment of complicated intra-abdominal infections: report from a swedish study group. Scand J Infect Dis 1996; 28: 507–12PubMedCrossRef
39.
De Groot HGW, Hustinx PA, Lampe AS, et al. Comparison of imipenem/cilastatin with the combination of aztreonam and clindamycin in the treatment of intra-abdominal infections. J Antimicrob Chemother 1993; 32: 491–500PubMedCrossRef
40.
Geroulanos SJ, Depuydt P, van Kershaver B, et al. Meropenem versus imipenem/cilastatin in intra-abdominal infections requiring surgery. J Antimicrob Chemother 1995; 36 Suppl. A: 191–205PubMedCrossRef
41.
Angeras MH, Darle N, Hamnström K, et al. A comparison of imipenem/cilastatin with the combination of cefuroxime and metronidazole in the treatment of intra-abdominal infections. Scand J Infect Dis 1996; 28 (5): 513–8PubMedCrossRef
42.
Kanellakopoulou K, Giamarellou H, Papadothomakos P, et al. Meropenem versus imipenem/cilastatin in the treatment of intra-abdominal infections requiring surgery. Eur J Clin Microbiol Infect Dis 1993; 12: 449–53PubMedCrossRef
43.
Solomkin JS, Reinhart HH, Dellinger EP, et al. Results of a randomized trial comparing sequential intravenous/oral treatment with ciprofloxacin plus metronidazole to imipenem/cilastatin for intra-abdominal infections. Ann Surg 1996; 223: 303–15PubMedCrossRef
44.
Solomkin JS, Wilson SE, Bennion RS, et al. Results of a prospective blinded rct comparing clinafloxacin (CLN) to imipenem/cilastatin (IMI) for complicated intra-abdominal infections. Proceedings of the 38th Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC); 1998 Sep 24–27; San Diego, CA
45.
Huizinga WKJ. Piperacillin/tazobactam: new evidence for the management of intra-abdominal infection. Proceedings of the 7th European Congress of Clinical Microbiology and Infectious Diseases; 1995 Mar 26–30; Vienna
46.
Karran S, Davey PG. Clinical efficacy and cost effectiveness of piperacillin/tazobactam vs. ampicillin + gentamicin + metronidazole in the treatment of intra-abdominal infections. Proceedings of the 18th International Congress of Chemotherapy; 1993 Jun 27–Jul 2; Stockholm
47.
Ravichandran D, Karran SE, Pallet A, et al. Monotherapy vs combination therapy in serious intra-abdominal infections: a prospective randomized study. Br J Surg 1994; 81 Suppl.: 75CrossRef
48.
Christou NV, Turgeon P, Wassef R, Canadian Intra-abdominal Infection Study Group, et al. Management of intra-abdominal infections. Arch Surg 1996; 131: 1193–201PubMedCrossRef
49.
Shadish WR, Haddock CK. Combining estimates of effect size. In: Cooper H, Hedges LV, editors. The handbook of research synthesis. New York (NY): Russell Sage Foundation, 1994: 261–81
50.
Strehl E, Brennscheidt U, Mülder P. Antibiotikatherapie schwerer infektionen. Krankenhauspharmazie 1995; 8: 330–5
51.
Simes R, Glasziou P. Meta-analysis and quality of evidence in the economic evaluation of drug trials. Pharmacoeconomics 1992; 1 (4): 282–92PubMedCrossRef
Metadata
Title
Cost Efficacy of Tazobactam/Piperacillin versus Imipenem/Cilastatin in the Treatment of Intra-Abdominal Infection
Authors
Dr Eva Susanne Dietrich
Björn Schubert
Winfried Ebner
Franz Daschner
Publication date
01-01-2001
Publisher
Springer International Publishing
Published in
PharmacoEconomics / Issue 1/2001
Print ISSN: 1170-7690
Electronic ISSN: 1179-2027
DOI
https://doi.org/10.2165/00019053-200119010-00006

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