Clinical practice and costs of treating catheter-related infections with teicoplanin or vancomycin
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.
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.
The authors hereby transfer, assign, or otherwise convey to Pharmacy Practice: (1) the right to grant permission to republish or reprint the stated material, in whole or in part, without a fee; (2) the right to print pr epublish copies for free distribution or sale; and (3) the right to republish the stated material in any format (electronic or printed). In addition, the undersigned affirms that the article described above has not previously been published, in whole or part, is not subject to copyright or other rights except by the author(s), and has not been submitted for publication elsewhere, except as communicated in writing to Pharmacy Practice with this document.
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License (CC-BY-NC-ND) that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.