1 / 17

Cost-Effective Analysis of Empiric Antibiotic Therapy For Suspected Enterococcal Bacteremia

Cost-Effective Analysis of Empiric Antibiotic Therapy For Suspected Enterococcal Bacteremia. Tom Hsiung, B.S.Pharm , ID 15221010857 SOP, China Pharmaceutical University Nanjing, Jiangsu, China. Background. Bloodstream infections ~ 1/3 of hospital-acquired infection

caia
Télécharger la présentation

Cost-Effective Analysis of Empiric Antibiotic Therapy For Suspected Enterococcal Bacteremia

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Cost-Effective Analysis of Empiric Antibiotic Therapy For Suspected Enterococcal Bacteremia Tom Hsiung, B.S.Pharm, ID 15221010857 SOP, China Pharmaceutical University Nanjing, Jiangsu, China

  2. Background • Bloodstream infections • ~ 1/3 of hospital-acquired infection • Significant morbidity (most often, LKC-CNS) • Significant mortality • Epidemiology of Enterococcus • 10% of all bloodstream infections

  3. The Overall Process • Step 1 Identify the specific decision • Step 2 Specify Alternatives • Step 3 Draw the Decision Analysis Structure • Step 4 Specify Possible Costs, Outcomes, and Probabilities • Final Step Perform Calculations

  4. Steps • Step 1 Identify the specific decision • Objective • Perspective • Time interval

  5. Step 1 Identify the Specific Decision • Objective • Gram stain cocci (+) [Blood] • Cost-effectiveness • Perspective – Patient, Provider, Payer, and Societal • Cost • Direct cost (drugs, supplies, lab test, provider’s time, hospitalization) • Outcome – Clinical and Humanistic • Time Interval – 30 days after hospitalization

  6. Steps • Step 2 Specify Alternatives • Most effective treatments • Innovative approach vs standard approach

  7. Step 2 Specify Alternatives • Antibiotic Approaches • Beta-lactam agent (standard) • Vancomycin (standard) • Antibiotics against vancomycin-resistant enterococci

  8. Steps • Step 3 Draw the Decision Analysis Structure • Choice node • Chance node • Terminal node

  9. Steps • Step 4 Specify Possible Costs, Outcomes, and Probabilities • Probability of occurrence • Consequences of the occurrence

  10. Step 4 Specify Possible Costs, Outcomes, and Probabilities • Costs • Ampicillin 2000 mg Q6h $27 • Vancomycin 1000 mg twice/day $8 • Daptomycin 420 mg/day $254 • Linezolid 600 mg IV twice/day $241 • Days until species identified 2 days • Days until susceptibilities return 4 days • Vancomycin-susceptible • Vancomycin-resistant enterococcus • Increased length of stay if not susceptible 0 days

  11. Step 4 Specify Possible Costs, Outcomes, and Probabilities • Probabilities, Outcomes • Gram positive cocci in chains identified as enterococcal50% • Prevalence of E. faecalis35% • Ampicillin susceptible 100% • Vancomycin susceptible 96% • Daptomycin susceptible 100% • 30-day mortality when susceptible to empiric 10% • 30-day mortality when non-susceptible empiric 13%

  12. Step 4 Specify Possible Costs, Outcomes, and Probabilities • Probabilities, Outcomes • Prevalence of E. faecium51% • Ampicillin susceptible 5.4% • Vancomycin susceptible 28.3% • Daptomycin susceptible 99.7% • 30-day mortality when susceptible to empiric 26% • 30-day mortality when non-susceptible empiric 45%

  13. Step 4 Specify Possible Costs, Outcomes, and Probabilities • Probabilities, Outcomes • Prevalence of other enterococcal species 14% • Ampicillin susceptible 86% • Vancomycin susceptible 86% • Daptomycin susceptible 100% • 30-day mortality when susceptible to empiric 10% • 30-day mortality when non-susceptible empiric 13%

  14. Steps • Final Step Perform Calculations • Costs • Consequences

  15. Final Step Perform Calculations • Costs of decision 1 • Arm 1 = (P1*P2*…Pn)*[∑(total cost of Arm1)] • Arm 2 • Arm n • Total costs of decision 1 = Arm 1+Arm 2+…+Arm n • Costs of decision 2 • Costs of decision n

  16. Final Step Perform Calculations • Outcomeof decision 1 • Arm 1 = (P1*P2*…Pn)*(Outcomeof Arm1) • Arm 2 • Arm n • Total outcomeof decision 1 = Arm 1+Arm 2+…+Arm n • Outcomeof decision 2 • Outcome of decision n

  17. Acknowledgement Thank You

More Related