Cost comparison of seven antibiotic combinations as empiric therapy in a simulated febrile neutropenic patient.

Total costs, drug and supply costs, and personnel costs for 14 days of therapy with seven therapeutically equivalent i.v. antibiotic combinations were calculated for a simulated febrile neutropenic patient. The cost for each antibiotic regimen was calculated using a previously developed computerized model that included the cost elements involved in preparation, administration, and pharmacokinetic monitoring of i.v. antibiotic therapy. Comparative costs for the seven antibiotic regimens were determined by inserting the costs of the individual elements into the model. Total costs for the 14 days of therapy varied greatly among the seven regimens, ranging from $908 to $2543. Antibiotics constituted the greatest percentage of total expenditures for each regimen (64-92%). Costs were increased substantially when a third-generation cephalosporin was included in the regimen. Antibiotic costs correlated strongly with total costs, while personnel costs correlated poorly with total costs and accounted for only 6-30% of the total expenditures. Computerized analysis of all costs involved in antimicrobial therapy for this simulated neutropenic patient showed that total costs varied widely in direct proportion to antibiotic costs. In selecting antimicrobial agents for high-risk patients, costs should be considered along with efficacy.