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The application of cost effectiveness analysis to derive a formulary for urinary tract infections
A Tramarin1, L Bragagnolo, K Tolley
1Department of Infectious Diseases, San Bortolo Hospital, Vicenza, Italy. tramarin@gpnet.it
Abstract:
According to economic principles an inappropriate prescription is the choice of an antimicrobial with higher/equivalent cost and lower effectiveness (or higher cost and equivalent/lower efficacy) than an alternative (in this case, the former is specified as a "dominated" drug). To identify cost-effective antibiotics we applied the principles of incremental cost-effectiveness analysis (ICEA) to microbiological data of San Bortolo Hospital. Its 27 wards were grouped in 9 functional areas. The resistance patterns of 8 urinary pathogens in the 1997 microbiology data base were assessed. The measure of antibiotic effectiveness was expressed as the percentage of isolates susceptible to each antibiotic tested. The difference in cost (i.e. the incremental change) between each antibiotic and the next more expensive alternative was calculated, and compared with the incremental change in effectiveness. Calculations were made for each pathogen. The antibiotics remaining after exclusion of all "dominated" antibiotics were pooled on a list defined as "Specific Area Formulary". The implications of the use of economic principles within a general antimicrobial policy are discussed.
Insights
This study used incremental cost-effectiveness analysis to identify cost-effective antibiotics for San Bortolo Hospital. The findings led to a formulary of effective and economical antimicrobial drugs.
Area of Science:
- Pharmacoeconomics
- Antimicrobial Stewardship
- Health Economics
Background:
- Antimicrobial resistance necessitates cost-effective prescribing.
- Economic principles can guide antibiotic selection.
- Incremental Cost-Effectiveness Analysis (ICEA) is a framework for evaluating value.
Observation:
- Microbiological data from San Bortolo Hospital (1997) were analyzed.
- Antibiotic effectiveness was measured by pathogen susceptibility rates.
- Cost and effectiveness data were compared for 8 urinary pathogens across 9 functional areas.
Findings:
- "Dominated" antibiotics (higher cost, lower effectiveness) were excluded.
- A "Specific Area Formulary" was created listing cost-effective options.
- ICEA identified antibiotics offering the best value for specific clinical areas.
Implications:
- Integrating economic principles into antimicrobial policy optimizes resource allocation.
- This approach supports evidence-based prescribing and reduces unnecessary costs.
- The developed formulary can guide antimicrobial stewardship programs.