Cost-Effectiveness of Ampicillin/Sulbactam Versus Imipenem/Cilastatin in the Treatment of Limb-Threatening Foot Infections in Diabetic Patients

Abstract

A cost-effectiveness analysis was performed following a double-blind, randomized study of ampicillin/sulbactam (A/S) versus imipenem/cilastatin (I/C) for the treatment of limb-threatening foot infections in 90 diabetic patients. There were no significant differences between the treatments in terms of clinical success rate, adverse-event frequency, duration of study antibiotic treatment, or length of hospitalization. Costs of the study antibiotics, treatment of failures and adverse events, and hospitalization were calculated. Mean per-patient treatment cost in the A/S group was $14,084, compared with $17,008 in the I/C group (P = .05), primarily because of lower drug and hospitalization costs and less-severe adverse events in the A/S group. Sensitivity analyses varying drug prices or hospital costs demonstrated that A/S was consistently more cost-effective than I/C. Varying the clinical success rate for each drug revealed that I/C would have to be 30% more effective than A/S to change the economic decisions.

Containing Costs and Containing Bugs: Are They Mutually Exclusive?

“…4,5 Studies that evaluated other serious infections in the hospital attribute less than 10% of overall health care costs to antimicrobials. [6][7][8][9] A recent study analyzed costs associated with managing hospitalized patients with CAP (PSI [Pneumonia Severity Index] Class IV and V) at a community health system during a 6-month period. 10 The median total hospital cost per patient was $5,078, while the antimicrobial acquisition cost accounted for $139 per patient (2.7% of the total cost).…”

A report from the international consensus on diagnosing and treating the infected diabetic foot

“…vancomycin, teicoplanin of therapy is an important factor in selecting a regimen, antibiotics account for only a small portion of the treatment costs for a foot infection [46]. Comparative trials and economic analyses of various anti-infective regimens are needed [47]. Empirical antibiotic recommendations, by type of infection, are given in Table 3.…”

Medical Treatment of Diabetic Foot Infections

“…Variables that explained 95% of the total treatment costs were the time intervals between diagnosis, the final required procedure, and wound healing and the number of surgical procedures performed [69]. One American study demonstrated that therapy with ampicillin/sulbactam was significantly less expensive than therapy with imipenem/cilastatin, for limb-threatening diabetic foot infections, primarily because of the lower drug and hospitalization costs and the less severe side effects associated with the former treatment [70]. More comparative trials and economic analyses are needed.…”