Kim Yun, Kim Soohyun, Park Jinsook, Lee Howard
Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Hospital, Seoul 03080, Korea.
Hanyang Medicine-Engineering-Bio Collaborative & Comprehensive Center for Drug Development (MEBC), Hanyang University, Seoul 04763, Korea.
J Pers Med. 2022 Jan 26;12(2):163. doi: 10.3390/jpm12020163.
Cost-effectiveness analysis has been widely used to assess and compare the costs and benefits of a clinical service. The cost-effectiveness of vancomycin therapeutic drug monitoring (TDM) has not been studied in the elderly, who are susceptible to vancomycin-induced adverse effects. This study was performed to evaluate if vancomycin TDM is cost-effective in elderly patients in the Republic of Korea. Using the electronic medical records at a tertiary university hospital, we performed a retrospective observational study to evaluate the cost-effectiveness of vancomycin TDM in 850 elderly patients who underwent vancomycin TDM with an appropriate, recommended dosing regimen and 1094 elderly patients who did not. Cost-effectiveness variables such as clinical outcomes and medical expenses were evaluated using univariate and multivariate analyses. The TDM group spent significantly less than the non-TDM group per patient for total medical expenses (by USD 841.40) and medication expenses (by USD 16.70). However, no significant difference was noted between the TDM and non-TDM groups in clinical outcomes such as microbiological cure, prevention of nephrotoxicity, or reduced mortality, irrespective of admission to the intensive care unit. Vancomycin TDM in elderly patients was associated with economic benefits, but not with better clinical outcomes.
成本效益分析已被广泛用于评估和比较临床服务的成本与效益。万古霉素治疗药物监测（TDM）的成本效益在易发生万古霉素诱导不良反应的老年人中尚未得到研究。本研究旨在评估万古霉素TDM在韩国老年患者中是否具有成本效益。利用一所三级大学医院的电子病历，我们进行了一项回顾性观察研究，以评估850例接受了合适的、推荐给药方案的万古霉素TDM的老年患者以及1094例未接受TDM的老年患者中万古霉素TDM的成本效益。使用单变量和多变量分析评估了诸如临床结局和医疗费用等成本效益变量。TDM组每位患者的总医疗费用（少841.40美元）和药物费用（少16.70美元）显著低于非TDM组。然而，无论是否入住重症监护病房，在微生物学治愈、预防肾毒性或降低死亡率等临床结局方面，TDM组和非TDM组之间均未观察到显著差异。老年患者的万古霉素TDM与经济效益相关，但与更好的临床结局无关。
