Cost-effectiveness analysis of therapy with standard antibiotics versus fluoroquinolone at Clinical Unit of diabetology, Medical University of ŁÓdŹ, Poland

Joanna Kusowska

Summary
Pharmacoeconomic studies of effectiveness, safety and costs of treatment have been scarce in Poland. Development of therapeutic standards for bacterial infections, based on pharmacoeconomic analysis and clinical studies evaluating treatment effectiveness and safety, allows for a more rational pharmacotherapy. The Alexander study of bacterial resistance to antibiotics conducted in Poland showed a high sensitivity of bacterial strains to simple and cheap antibiotics.
Aim
Clinical questions to be answered:
? Is the empirical therapy with cheap standard antibiotics [SAT] more effective than that with fluoroquinolone [FT] in patients with severe bacterial infections?
? What is the frequency of therapeutic failure in patients in severe clinical condition who were offered SAT or FT?
? What are the direct costs of the treatment of bacterial infections at the Clinical Unit in Łódź?
? What financial consequences may result from the introduction of treatment guidelines in bacterial infections, and a 5-day shorter hospital stay?
Material and methods
A prospective, randomized, single blind, pharmacoeconomic study was carried out in 420 patients with bacterial infections, admitted to our hospital from 1 July 2002 to 31 December 2002, who were given SAT versus FT.
Therapeutic effectiveness was evaluated daily from complaints reported by patients, complete physical examination, selected diagnostic and laboratory tests. The effectiveness of pharmacotherapy and the frequency of adverse drug reactions (ADR) were recorded.
The economic evaluation was done by assessing the direct cost of the treatment of patients with severe bacterial infections. Finally, the statistical significance was evaluated.
Results
Effectiveness: Empirical sequential SAT vs FT therapy administered at the Clinical Unit of Diabetology, Łódź, Poland showed similar effectiveness, i.e. 87% and 90% respectively.
Cost estimation: The direct costs of the therapy were low - approximately 85 USD vs. 83 USD with therapeutic success, and 126 USD vs. 97 USD with therapeutic failure. The cost of specialist consultation per patient during the treatment accounted for 0.85% - 1.38% of the resources allocated by the Health Care Fund for patient hospital stay. Sequential pefloxacin therapy resulted in direct cost savings (excluding hotel cost) of about 2450 USD per 1000 patients, which was economically significant.
Conclusion
In order to reduce the costs and increase the effectiveness at the Clinical Unit of Diabetology, we followed the therapeutic guidelines for bacterial infections, which resulted in high effectiveness and reduced hospital stay from 13 to 8 days, with cost-effectiveness of approximately 101,850 USD per 1000 patients.

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