Clinical practice and costs of treating catheter-related infections with teicoplanin or vancomycin

Main Article Content

Steven Simoens
Nik De Corte
Gert Laekeman

Keywords

Glycopeptide, Teicoplanin, Vancomycin, Cost minimisation analysis, Belgium

Abstract

Objectives: To elicit actual clinical practice of treating intensive care unit patients with catheter-related infections with teicoplanin or vancomycin from a hospital perspective. As clinical trials have demonstrated similar efficacy of these glycopeptides, a cost-minimisation analysis was also carried out.

Methods: The Delphi survey technique was used to gather the opinion of nine physicians regarding resource utilization associated with teicoplanin and vancomycin. Treatment costs considered were costs of drug acquisition, costs of material and nursing time required for drug preparation and administration, and costs of laboratory tests.

Results: Physicians tend to administer higher loading doses of teicoplanin than recommended in the drug information leaflet. Even though evidence of the effectiveness of vancomycin is mainly derived from trials using multiple-daily administration schedules, five physicians administered it on a once-daily basis. Mean treatment costs amounted to 1,272€ with teicoplanin and 1,041€ with vancomycin. Higher treatment costs with teicoplanin arose from more elevated drug acquisition costs (1,076€ versus 795€). Treatment with vancomycin was associated with higher costs of laboratory tests as a result of more frequent monitoring of serum concentrations (217€ versus 150€).

Conclusions: This analysis of clinical practice and costs indicated that the resource utilisation advantages from fewer laboratory tests with teicoplanin partially offset higher drug acquisition costs. In addition to efficacy and costs, other factors such as route of administration, patient profile and adverse effects need to inform the choice between teicoplanin and vancomycin.

Abstract 761 | PDF Downloads 475

References

1. Wood MJ. The comparative efficacy and safety of teicoplanin and vancomycin. J Antimicrob Chemother 1996; 37: 209-22.

2. Zeckel ML. A closer look at vancomycin, teicoplanin, and antimicrobial resistance. J Chemother 1997; 9: 311-35.

3. Davey PG, South R, Malek MMH. Impact of glycopeptide therapy after hospital discharge on inpatient costs: a comparison of teicoplanin and vancomycin. J Antimicrob Chemother 1996; 37: 623-33.

4. Abad F, Calbo F, Zapater P, Rodriguez-Vilanova F, Garcia-Perez LE, Sacristan JA. Comparative pharmacoeconomic study of vancomycin and teicoplanin in intensive care patients. Int J Antimicrob Agents 2000; 15: 65-71.

5. Powell C. The Delphi technique: myths and realities. J Adv Nurs 2003; 41: 376-82.

6. Whitman N. The committee meeting alternative: using the Delphi technique. J Nurs Adm 1990; 20: 30-7.

7. McKenna HP. The Delphi technique: a worthwile approach for nursing? J Adv Nurs 1994; 19: 1221-5.

8. Wilson APR. Comparative safety of teicoplanin and vancomycin. Int J Antimicrob Agents 1998; 10: 143-52.

9. Hasson F, Keeney S, McKenna H. Research guidelines for the Delphi survey technique. J Adv Nurs 2000; 32: 1008-15.

10. Vacani PF, Malek MMH, Davey PG. Cost of gentamicin assays carried out by microbiology laboratories. J Clin Pathol 1993; 46: 890-5.

11.Red men should go: vancomycin and histamine release. Lancet 1990; 335: 1006-7.