Comparative cost effectiveness of gentamicin and tobramycin

Area of Science:

• Pharmacoeconomics
• Infectious Diseases
• Nephrology

Background:

• Aminoglycosides like gentamicin and tobramycin are crucial for treating serious bacterial infections.
• Nephrotoxicity is a significant adverse effect associated with aminoglycoside use.
• Comparative cost-effectiveness data for these agents in adult general medical services are essential for clinical decision-making.

Purpose of the Study:

• To compare the cost-effectiveness of gentamicin versus tobramycin in adult patients with serious infections.
• To evaluate the economic impact of differing nephrotoxicity rates between the two aminoglycosides.

Main Methods:

• A randomized double-blind trial comparing gentamicin and tobramycin was utilized.
• Cost data from 1984, including drug acquisition and nephrotoxicity-related expenses, were analyzed.
• Sensitivity analysis was performed to assess the impact of various cost factors and hospitalization durations.

Main Results:

• The incidence of nephrotoxicity was higher with gentamicin (26%) compared to tobramycin (12%).
• Despite higher drug costs, gentamicin demonstrated lower combined average drug and nephrotoxicity costs ($72) versus tobramycin ($127) per patient.
• Gentamicin remained more cost-effective unless hospitalization was prolonged significantly due to tobramycin-induced nephrotoxicity.

Conclusions:

• Gentamicin presents a more favorable cost-effectiveness profile than tobramycin for treating serious infections in adult general medical settings.
• The economic advantage of gentamicin is contingent on avoiding prolonged hospital stays associated with tobramycin's higher nephrotoxicity rate.
• Clinical and economic considerations necessitate careful evaluation of aminoglycoside choice based on patient-specific factors and potential adverse outcomes.