Tuesday, October 02, 2007

Costs and Efficacy

The cost of iv antibiotics was a question raised recently in conference. Is cost a real consideration in deciding which antibiotic to give a patient? I thought this was interesting since a group of my colleagues was recently invited to a night of drinking at a bar in New York on the basis that we should prescribe levaquin (Ortho McNeil) instead of avelox (Bayer) for community acquired pneumonia.

I ran across some interesting
, including one, the European MOTIV study which compared avelox to levaquin head to head, showing outpatient use of avelox to be as effective as combined levaquine (twice daily iv) and ceftriaxone (2 grams iv).

There is some concern about quinolones, particularly in the elderly for risks of QT prolongation and tendon ruptures and muskuloskeletal effects(young, old, athletes), and oder quinolones such as cipro do not cover strep very well, and the risk for quinolone resistance due to widespread use for example in the treatment of UTI.

One of our pediatric attendings suggested that quinolones have been used in the pediatric age group in Europe, however I suggested that on the basis of my European experience these agents were often avoided in the young active or elderly patient due to the risks of Achilles Tendon rupture. http://www.jabfm.org/cgi/content/full/16/5/458

In my quiz last week I asked which antibiotic combination is most expensive, the winner for most expensive is TNT- tobramycin and timentin...narrowly beating out zosyn.. both at around 56$ per day from my cost source, this is somewhat old though, since cipro has since gone generic...

and the cheapest- amp-gent, comes in at less than 10 dollars per day.

Yet a better question, at least for those patients, for example with community acquired pneumonia, is probably who should be admitted, and who should be sent home, and what is the most efficient way of arriving at that decision in the emergency department...use of Pneumonia severity indices is one way of doing that, as shown. The AHRQ has a set of guidelinesfor treating pneumonia on an outpatient basis which are useful, in one estimate, the cost of treating an admitted patient for pneumonia is $3000, vs $300 for an outpatient treatment plan.

as follows- the base cost (drug only, not including IV or nurse) of giving a patient the following drugs for 24 hours, obtained from this site at Wisconsin Medical College. Note this is not what the hospital bills...

ampicillin- $ 8.80 (generic)
azithromycin- $19.19
unasyn- $36.66
ceftriaxone- $ 23.11
cipro- $ 33.88 not accurate- now generic.
clindamycin- $22.89
gentamicin $1.05(generic)
timentin $48.72
tobramycin-$7.77 (generic)
vancomycin $10.74 (generic)
Zosyn- $56.00

1 comment:

S. said...

on a different topic on an old comment you left on my blog about the movie Once, what's a busker?!? hope you're staying warm out there. My friend in her ob/gyn residency in nyc says it's been cold.