Objective: To determine if dual individualization of cefmenoxime dosing is cost-effective.
Design: Retrospective, pharmacoeconomic decision analysis of two consecutively conducted prospective clinical studies.
Patients: Patients with documented gram-negative nosocomial pneumonia were evaluated. Thirty-three patients received cefmenoxime at standard dosing and 28 patients received doses according to dual individualization methodology.
Main outcome measure: Antibiotic and infection-related costs were compared between groups. The number of hospital antibiotic days and costs incurred on those days were also evaluated. A decision model was constructed to characterize differences in treatment outcome. Probabilities within the decision tree were derived from 61 evaluable patients. Cost-effectiveness and incremental cost-effectiveness ratios were calculated. Sensitivity analysis was performed by varying outcome probabilities, antibiotic prices, and hospital room costs.
Results: Antibiotic and infection-related costs (mean +/- SEM) were $848 +/- 78 for standard cefmenoxime dosing and $1123 +/- 128 for dual individualization (p < 0.05). Total hospital costs were $10,660 +/- 1432 for standard dosing and $11,709 +/- 1900 for dual individualization (p > 0.05). Median antibiotic length of stay (ALOS) was 15.2 and 12.7 days for standard and dual individualization methodologies, respectively (p > 0.05). Incremental analysis of cost-effectiveness indicated that a similar reduction in length of stay for 259 dual individualization patients would save $321,808 annually.
Conclusions: Sensitivity analysis indicates that, by reducing ALOS, dual individualization could be a cost-effective method of beta-lactam dosing for patients with pneumonia. A prospective study should be conducted to validate these findings.