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Abstract

COST-MINIMIZATION ANALYSIS OF MEROPENEM VERSUS IMIPENEM/CILASTATIN IN MODERATE TO SEVERE INFECTIONS AT A TERTIARY CARE GOVERNMENT TEACHING HOSPITAL – A PHARMACOECONOMIC AND EPIDEMIOLOGICAL STUDY

B. N. V. Bhargavi Sri Lakshmi*, M. Prudhvi Kumar, N. V. Rama Rao

ABSTRACT

Background: Antibiotics are playing very crucial role in every health care system. According to WHO 2009 statistics almost 50% of the patients in India (Karnataka) are using antibiotics regularly and repeatedly over a period of life time1.The updated Pharmacoeconomic and epidemiological studies on antibiotics are scarce in India. Aim: The main aim of this study is to compare the costs of imipenem/cilastatin and meropenem in management of moderate to severe infections in different diagnosed patients. These both drugs are belonged to the carbapenem class of drugs, sharing a similar spectrum of activity. Methodology: It is a retrospective longitudinal (Cohort) study including 90 patients with moderate to severe infections managed with Imipenem/Cilastin and Meropenem were observed simultaneously in the period of September 2014 to December 2014. The data was collected from the medical records, following by physician notes and through counselling few patients who are on regular follow up. Cost Minimization Analysis was used to find out the best economic drug among them based on the ROA (Route of Administration), Frequency, Dose, length of hospitalization and other aspects were well considered. Patients with >18 yrs age group were considered in this study. Paediatrics population were excluded as the documentation was incomplete. Patients who are diagnosed with moderate to severe infections include Urinary Tract Infections, Abdominal Infections, Sepsis, and Respiratory tract infections, Skin Infections, Hospital Acquired Infections, who were prescribed with imipenem/cilastatin500 mg q6 hr. i.v or meropenem 1gram q8 hr. Were included in the study. As the study area is in a government setup only medication cost was included in accordance with payer perspective. Results: The total number of cases attended to General Medicine Department from September 2014 to December 2014 is 348. The total number of moderate to severe infection cases attended to General Medicine Department in a tertiary care hospital in 4 months of time period was 151, among them 90 patients were taken as subjects for demonstration of analysis of meropenem versus imipenem/cilastatin. Most of the cases were between 21 to 40 years of age group, resides in the rural areas. There is a significant difference in the mean total daily costs between the two drugs [statistically analysed report] is (4356 of imipenem/cilastatin, 3240 for meropenem). The cost of administration set, also rocketed the daily cost of imipenem/Cilastin. There is no documented ADR (Adverse Drug Reaction) reporting forms in these cases. Conclusion: The study has shown that the mean total cost of meropenem 1g q8 hr. is lower than the cost of imipenem/Cilastin at a dose of 500mg q6hr.This study partially states that the cost of drugs in managing the moderate to severe infections are crucial elements of the overall costs. They also to be considered along with non-medical costs and intangible cost in case of policy making.

Keywords: Imipenem/cilastatin, Meropenem, Moderate to severe infections, Pharmacoeconomics, pharmacoepidemiology, payer perspective.


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