Decision analysis modelling of costs and outcomes following cefepime monotherapy in Canada

To evaluate the comparative cost of treatment and intermediate outcomes (percentage resistant organisms, days in hospital, etc) among cefepime and alternative parenteral antibiotics used for empiric monotherapy.

Decision analysis model, based on published literature, clinical trial results and information from infectious disease clinicians.

A Canadian tertiary care hospital.

Comparison of cefepime, ceftazidime, ceftriaxone, cefotaxime and ciprofloxacin in the treatment of lower respiratory tract infections, urinary tract infections, skin/soft tissue infections, septicemia and febrile neutropenia.

Cefepime treatment results in the lowest average cost per patient when used as initial empiric therapy for lower respiratory tract infections and for skin/soft tissue infections. Cefepime therapy is among the lowest cost treatments for the other infectious disease conditions and has the lowest cost for a weighted 'average' condition. Sensitivity analysis indicates that model results are most sensitive to duration of hospitalization.

Initial empiric monotherapy with cefepime for serious infectious disease conditions may result in cost savings compared with alternative parenteral agents.