Kalatharan L, Ferman M, Kumar S, Rajendra S, Pripanapong S, Wu Y, Richards H, Rogers B A
Hospital in the Home, Monash Health, Clayton, Victoria, Australia.
Department of Pharmacy, Monash Health, Clayton, Victoria, Australia.
Open Forum Infect Dis. 2023 Oct 6;10(11):ofad505. doi: 10.1093/ofid/ofad505. eCollection 2023 Nov.
The application of antimicrobial stewardship (AMS) principles may entail increased cost to allow for narrower-spectrum therapy. Prescribing benzylpenicillin (BP) and ceftriaxone (CRO) for outpatient parenteral antimicrobial therapy (OPAT) demonstrates the complex challenge of this principle. The aim of this study is to analyze the use of BP and CRO in our OPAT program, including indications and relative cost.
We analyzed all adult patients in our OPAT program who received intravenous BP or CRO over 1 year. We identified a "crossover group" of patients who could have received either agent. Economic comparison was based on acquisition cost of the therapy (drug, infuser, and preparation costs).
Of 105 eligible patients, 54 (51%) and 51 (49%) received BP and CRO, respectively. Forty (38%) patients were suitable for either agent; of these, the majority (n = 31, 78%) were treated with BP. Economic analysis demonstrated that the average daily cost of BP therapy was $93.76/d (AUD) vs $1.23/d for CRO. Thus, across our OPAT programs, we had an additional average cost of $92.53/patient/d to use BP instead of CRO. Program-wide the annual additional cost of using BP and thus applying this AMS strategy was $68 386.12.
BP is often selected over CRO by clinicians, where possible, as recommended by the Australian guidelines; however, BP is associated with higher daily acquisition costs. More broadly, a number of narrower-spectrum agents may involve significantly higher costs than comparators; as such, the $92.53/d to prevent CRO exposure can be considered when applying other antimicrobial-substitution AMS interventions in an acute health care setting.
应用抗菌药物管理（AMS）原则可能会增加成本，以实现使用更窄谱的治疗方法。在门诊胃肠外抗菌治疗（OPAT）中使用苄青霉素（BP）和头孢曲松（CRO）体现了这一原则面临的复杂挑战。本研究的目的是分析BP和CRO在我们的OPAT项目中的使用情况，包括适应证和相对成本。
我们分析了在1年期间接受静脉注射BP或CRO的所有参与我们OPAT项目的成年患者。我们确定了一组“交叉组”患者，他们本可以接受任何一种药物治疗。经济比较基于治疗的采购成本（药物、输液器和配制成本）。
在105例符合条件的患者中，分别有54例（51%）和51例（49%）接受了BP和CRO治疗。40例（38%）患者适合使用任何一种药物；其中，大多数（n = 31，78%）接受了BP治疗。经济分析表明，BP治疗的平均每日成本为93.76澳元/天，而CRO为1.23澳元/天。因此，在我们所有的OPAT项目中，使用BP而非CRO，每位患者每天的额外平均成本为92.53澳元。在整个项目范围内，使用BP并因此应用该AMS策略的年度额外成本为68386.12澳元。
临床医生通常会根据澳大利亚指南的建议，在可能的情况下选择BP而非CRO；然而，BP的每日采购成本更高。更广泛地说，一些窄谱药物可能比对照药物的成本高得多；因此，在急性医疗环境中应用其他抗菌药物替代AMS干预措施时，可以考虑每天92.53澳元以避免使用CRO的成本。
