Cost issues in sequential therapy

Pharmacoeconomics is starting to be employed in strategic therapeutic decision making. Costs associated with antimicrobials included: (i) acquisition costs; (ii) preparation, administration and consumables costs; (iii) monitoring costs; (iv) costs of unwanted drug effects; (v) costs of resistance and therapeutic failures and (vi) costs of duration of stay. Most hospitals have a Drug and Therapeutics Committee but acquisition costs are still the most important economic criterion for acceptance for use, even though medicines only consume between 3 and 5% of total revenue costs, of which antibiotics account for around 15%. In any sequential programme acquisition costs and consumables are immediately realizable. Staff time and monitoring tests are less realizable but require changes in the way budgets are handled. Microbial resistance and risk management are difficult to quantify but are increasingly becoming important in strategic decision-making. The educational needs of health care decision makers in economic need addressing and mechanisms need to be put in place to enable the putative savings reported in the pharmacoeconomic literature to be realized.