ECONOMIC EVALUATION OF IMIPENEM-CILASTATIN VERSUS DORIPENEM IN VENTILATORASSOCIATED PNEUMONIA IN EGYPT

摘要

Objective: One of the most common complications of critical illness among surgical and trauma patients is ventilator-associated pneumonia (VAP). The mortality rate increases due to inappropriate empiric treatment of VAP. The rates of Pseudomonas aeruginosa (PA) VAP susceptibility to doripenem (DOR) are higher than those to imipenem-cilastatin (IMI). Cost-effectiveness analysis was developed to define outcome differences between strategies of empiric treatment of VAP with DOR versus IMI in Egyptian patients. Methods: A cost-effectiveness model was designed comparing empiric treatment of VAP with DOR versus IMI from the health insurance perspectives. The differences in the total costs and quality-adjusted life years (QALYs) under each scenario were examined, and sensitivity analyses were conducted to determine the stability of our estimates. Drug costs were taken from health insurance hospitals, with other inputs derived from the literature. Results: Deterministic baseline results from the model of DOR compared to IMI in the treatment of VAP suggest that DOR is more effective and less expensive than IMI. The total costs for IMI and DOR were Egyptian pound (EGP) 4646.93 and EGP 4197.58, respectively. QALYs for IMI and DOR were 0.53 and 0.54, respectively. Conclusions: Given the microbiologic sensitivity profile of PA to DOR and IMI, and depending on the local susceptibility patterns in institutions where DOR in vitro susceptibilities are superior to those of other carbapenems for PA clinical isolates, empiric treatment of VAP with DOR may dominate that with IMI by being both life- and cost-saving.