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Cost effectiveness of teicoplanin and ceftriaxone: a once-daily antibiotic regimen
1Hospital St. Louis, Paris, France.
Insights
A new once-daily antibiotic regimen of teicoplanin and ceftriaxone offers an effective and cost-saving alternative for treating febrile neutropenic children with central venous lines, reducing both drug expenses and nursing time.
Area of Science:
- Pediatric Infectious Diseases
- Hematology-Oncology
- Pharmacoeconomics
Background:
- Febrile neutropenia in children, particularly those with central venous lines, frequently involves staphylococcal infections.
- Current empiric antimicrobial therapy involves broad-spectrum coverage, often with conventional multi-dose regimens.
Purpose of the Study:
- To evaluate the efficacy and cost-effectiveness of a once-daily teicoplanin-ceftriaxone regimen compared to a conventional vancomycin-ceftazidime regimen in febrile neutropenic children.
- To assess potential cost savings in terms of antibiotics, materials, and nursing time.
Main Methods:
- A comparative study involving 41 febrile children treated with vancomycin plus ceftazidime (conventional regimen).
- Evaluation of a once-daily regimen of teicoplanin plus ceftriaxone in 47 febrile children.
- Cost-effectiveness analysis using French drug pricing data, including antibiotic costs, materials, and nursing time.
Main Results:
- The once-daily teicoplanin-ceftriaxone regimen demonstrated an equivalent response rate and treatment duration compared to the conventional regimen.
- Significant cost savings were observed with the teicoplanin-ceftriaxone regimen, estimated at 478 FF ($80 US) per 16-day course for drugs and materials.
- The new regimen saved approximately 14 hours of nursing time per patient, with potential monthly savings of 7,641 FF ($1,273 US) for hospital wards.
Conclusions:
- Once-daily teicoplanin and ceftriaxone provide an effective treatment option for febrile neutropenic children.
- This regimen offers substantial economic benefits through reduced antibiotic costs, material usage, and nursing workload.
- The findings support the adoption of this simplified, cost-effective therapeutic approach in pediatric oncology settings.
Abstract:
There is a high incidence of staphylococcal infection in febrile neutropenic children with a central venous line. These patients are usually initially treated with empiric antimicrobial therapy that provides broad spectrum coverage. In a study evaluating a conventional regimen of vancomycin 40 mg/kg/d plus ceftazidime 100 mg/kg/d given in three divided doses to 41 febrile children with leukemia or lymphoma, the response rate was 87% after a mean treatment duration of 16 days. A once-daily regimen of an investigational antibiotic, teicoplanin, 10 mg/kg/d and ceftriaxone 50 mg/kg/d evaluated in 47 febrile children with leukemia was found to produce an equivalent rate of success and require the same mean duration of therapy. A cost-effectiveness analysis comparing the economic impact of replacing the conventional regimen with once-daily teicoplanin-ceftriaxone revealed that a 16-day course of the latter treatment would produce cost savings in terms of the cost of the antibiotics and other nonreusable materials, as well as in nursing time. Using French drug pricing data, the savings calculated for drugs and materials were 478 FF ($80 US). The teicoplanin-ceftriaxone regimen saved approximately 14 hours in nursing time per patient. Extrapolations based on estimates of hospital occupancy and the ratio of days a patient receives antibiotic therapy to the total duration of hospital stay suggest that an average hospital ward could achieve monthly costsavings of 7,641 FF ($1,273 US) for antibiotics and materials.