Pharmacoeconomics of aztreonam-clindamycin versus gentamicin-clindamycin in the treatment of penetrating abdominal injury

Timothy Fabian, Bradley Boucher, Martin Croce

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Study Objective. To evaluate the pharmacoeconomic implications of using aztreonam-clindamycin (A-C) versus gentamicin-clindamycin (G-C) from the perspective of the hospital and pharmacy directors. Design. Pharmacoeconomic analysis performed at one of the sites participating in the prospective, randomized, double-blind, comparative, multicenter efficacy study. Setting. Referral hospital with level 1 trauma center. Patients. Eight-five adults with a suspected penetrating intraabdominal injury requiring laparotomy. Interventions. Patients were randomized to receive aztreonam 2 g intravenously every 8 hours or gentamicin 2 mg/kg intravenous load followed by 5 mg/kg/day intravenously initially adjusted to peak concentrations of 6- 8 μg/ml. All patients received clindamycin 900 mg intravenously every 8 hours. Measurements and Main Results. Charge data were gathered from the hospital billing system and converted to cost data using an institutional cost:charge ratio of 0.6. Study drug and aminoglycoside monitoring costs were also calculated. Overall, 43 (97%) of 44 patients receiving A-C had a favorable clinical response compared with 35 (85.4%) of 41 receiving G-C (p=0.052). The mean hospital cost of $66,336 for 7 infected patients was significantly higher than that of $8014 in 78 noninfected patients (p<0.0001.). Mean hospital costs of $12,058 and $13,742 for A-C and G-C groups, respectively, were not significantly different (p>0.05) despite having only a single failure (total cost $162,666) in the A-C group. Similarly, mean pharmacy costs of $1411 and $1604, respectively, were not significantly different (p>0.05). Conclusions. Hospital costs for infected patients with penetrating abdominal trauma exceed those of noninfected patients by 5-fold. Despite a lower infection rate in the A-C group, neither hospital nor pharmacy costs were significantly different compared with those in the G-C group.

Original languageEnglish (US)
Pages (from-to)951-957
Number of pages7
JournalPharmacotherapy
Volume16
Issue number5 I
StatePublished - Sep 1 1996

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Aztreonam
Abdominal Injuries
Pharmaceutical Economics
Clindamycin
Gentamicins
Costs and Cost Analysis
Hospital Costs
Therapeutics
Drug Monitoring
Trauma Centers
Wounds and Injuries
Aminoglycosides
Laparotomy
Multicenter Studies
Referral and Consultation

All Science Journal Classification (ASJC) codes

  • Pharmacology (medical)

Cite this

Pharmacoeconomics of aztreonam-clindamycin versus gentamicin-clindamycin in the treatment of penetrating abdominal injury. / Fabian, Timothy; Boucher, Bradley; Croce, Martin.

In: Pharmacotherapy, Vol. 16, No. 5 I, 01.09.1996, p. 951-957.

Research output: Contribution to journalArticle

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title = "Pharmacoeconomics of aztreonam-clindamycin versus gentamicin-clindamycin in the treatment of penetrating abdominal injury",
abstract = "Study Objective. To evaluate the pharmacoeconomic implications of using aztreonam-clindamycin (A-C) versus gentamicin-clindamycin (G-C) from the perspective of the hospital and pharmacy directors. Design. Pharmacoeconomic analysis performed at one of the sites participating in the prospective, randomized, double-blind, comparative, multicenter efficacy study. Setting. Referral hospital with level 1 trauma center. Patients. Eight-five adults with a suspected penetrating intraabdominal injury requiring laparotomy. Interventions. Patients were randomized to receive aztreonam 2 g intravenously every 8 hours or gentamicin 2 mg/kg intravenous load followed by 5 mg/kg/day intravenously initially adjusted to peak concentrations of 6- 8 μg/ml. All patients received clindamycin 900 mg intravenously every 8 hours. Measurements and Main Results. Charge data were gathered from the hospital billing system and converted to cost data using an institutional cost:charge ratio of 0.6. Study drug and aminoglycoside monitoring costs were also calculated. Overall, 43 (97{\%}) of 44 patients receiving A-C had a favorable clinical response compared with 35 (85.4{\%}) of 41 receiving G-C (p=0.052). The mean hospital cost of $66,336 for 7 infected patients was significantly higher than that of $8014 in 78 noninfected patients (p<0.0001.). Mean hospital costs of $12,058 and $13,742 for A-C and G-C groups, respectively, were not significantly different (p>0.05) despite having only a single failure (total cost $162,666) in the A-C group. Similarly, mean pharmacy costs of $1411 and $1604, respectively, were not significantly different (p>0.05). Conclusions. Hospital costs for infected patients with penetrating abdominal trauma exceed those of noninfected patients by 5-fold. Despite a lower infection rate in the A-C group, neither hospital nor pharmacy costs were significantly different compared with those in the G-C group.",
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