Computer modelling antibiotic therapy costs. Impact of therapeutic range

Computer modelling techniques were used to examine the economic consequences of intravenous chemotherapy of serious infection. Acquisition cost of the drug was found to be a poor predictor of global cost, since inclusion of the preparation and administration costs and projected laboratory and drug complication costs narrow, or even reverse, apparent cost differentials between drugs. Thus, the cost per day for acquisition/total treatment (in US dollars) are: penicillin $5/$30, gentamicin $1/$46, amikacin $26/$63, clindamycin $38/$57, metronidazole $12/$20 and cefotaxime $47/$60. 'Triple therapy' involving gentamicin ($0.40/dose) resulted in higher hospital costs than the equivalent regimen involving cefotaxime ($16/dose). Even when the purchase price is high, humanitarian considerations advocate the use of safe, predictable, efficacious drugs. Fortunately, the present analysis suggests that such drugs frequently result in the lowest total treatment cost. Current cost containment efforts that are based on acquisition costs only are flawed and may result in both suboptimal care and higher actual costs.