Práctica clínica y costes al tratar infecciones por catéter con teicoplanina o vancomicina

Abstract

Objectives: To elicit actual clinical practice of treating intensive care unit patients with catheterrelated infections with teicoplanin or vancomycin from a hospital perspective. As clinical trials have demonstrated similar efficacy of these glycopeptides, a cost-minimisation analysis was also carried out. Methods: The Delphi survey technique was used to gather the opinion of nine physicians regarding resource utilization associated with teicoplanin and vancomycin. Treatment costs considered were costs of drug acquisition, costs of material and nursing time required for drug preparation and administration, and costs of laboratory tests. Results: Physicians tend to administer higher loading doses of teicoplanin than recommended in the drug information leaflet. Even though evidence of the effectiveness of vancomycin is mainly derived from trials using multiple-daily administration schedules, five physicians administered it on a once-daily basis. Mean treatment costs amounted to 1,272€ with teicoplanin and 1,041€ with vancomycin. Higher treatment costs with teicoplanin arose from more elevated drug acquisition costs (1,076€ versus 795€). Treatment with vancomycin was associated with higher costs of laboratory tests as a result of more frequent monitoring of serum concentrations (217€ versus 150€). Conclusions: This analysis of clinical practice and costs indicated that the resource utilisation advantages from fewer laboratory tests with teicoplanin partially offset higher drug acquisition costs. In addition to efficacy and costs, other factors such as route of administration, patient profile and adverse effects need to inform the choice between teicoplanin and vancomycin.

Local Prophylactic Teicoplanin Effect on Spinal Fusion Surgery: A Comparative Retrospective Study

“…In clinical practice, several studies have demonstrated that teicoplanin and vancomycin have comparable effectiveness in the treatment of gram-positive infections. [46][47][48][49] Although teicoplanin has higher acquisition costs, its advantages such as a longer half-time, lower side effects, and lack of requirement for routine serum monitoring besides its superior tolerability give it considerable potential preference. [47][48][49] Sancar et al found that the acquisition costs of vancomycin were significantly lower; however, the administration, monitoring, and complications costs were significantly higher.…”

“…[46][47][48][49] Although teicoplanin has higher acquisition costs, its advantages such as a longer half-time, lower side effects, and lack of requirement for routine serum monitoring besides its superior tolerability give it considerable potential preference. [47][48][49] Sancar et al found that the acquisition costs of vancomycin were significantly lower; however, the administration, monitoring, and complications costs were significantly higher. 48 The authors figured out that the total therapy costs per patient have not differed significantly in comparisons between both medications.…”

“…Once-daily teicoplanin dose administration through different routes is feasible thanks to its longer half-life when compared with vancomycin. 47 There is no problem regarding the availability of both medications in powder formats worldwide. Several pharmacoeconomic analysis-based studies from several countries have compared the costs of teicoplanin and vancomycin.…”

“…Several pharmacoeconomic analysis-based studies from several countries have compared the costs of teicoplanin and vancomycin. 47,48,50,51 Since we used them locally in the operation field, comparing product costs will be more logical than comparing all treatment costs. A recently published study 50 from the United States stated that the product cost was found to be $3.06/g for vancomycin powder; however, it ranges between $2.50 and $44 in the literature.…”

“…Once-daily teicoplanin dose administration through different routes is feasible thanks to its longer half-life when compared with vancomycin. 47…”