HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Tice, A. D. Articles by Abramson, M. A. Search for Related Content PubMed PubMed Citation Articles by Tice, A. D. Articles by Abramson, M. A.

ALAN D. TICE, M.D., is Associate Professor of Internal Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu. ROBIN S. TURPIN, PH.D., is Director, Outcomes Research and Management, Merck and Company, Inc., West Point, PA, and Senior Scholar, Department of Health Policy, Jefferson Medical College, Philadelphia, PA. CHRISTOPHER T. HOEY, PHARM.D., is Clinical Associate Professor of Pharmacy, University of Washington, Seattle, WA, and Coordinator, Program for Intravenous Outpatient Therapy, Department of Veterans Affairs Puget Sound Health Care System (VAPSHCS), Seattle, WA. BENJAMIN A. LIPSKY, M.D., is Professor of Medicine, University of Washington, Seattle, WA, and Director, Primary Care Clinic, Antibiotic Research, VAPSHCS. JASMANDA WU, PH.D., is Senior Manager, Merck and Company, Inc., West Point, PA. MURRAY ABRAMSON, M.D., is Senior Director, Clinical Development, Merck and Company, Inc., Horsham, PA.

Address correspondence to Dr. Turpin at Outcomes Research and Management, WP 39-166 ORM, Merck and Company, Inc., Sumneytown Pike, West Point, PA 19486 (robin_turpin{at}merck.com).

Purpose. To evaluate potential cost savings, trial data were used to determine the clinical outcomes for i.v. ertapenem given once daily and i.v. piperacillin–tazobactam given every six hours daily in treating diabetic foot infections. Methods. A cost-minimization analysis (CMA) was conducted on the drug-dosing data of the subset of patients enrolled in a recent double-blind randomized trial who were treated solely as inpatients and were clinically evaluable at fi nal assessment (n = 99). Cost per dose was calculated from (a) average hospital acquisition price per dose for ertapenem ($40.52) or piperacillin–tazobactam ($13.58), (b) average U.S. wages and benefi ts for labor, based on nine published time-and-motion studies of i.v. antibiotic preparation and administration ($3.10), and (c) consumable supplies, using a 40% discount off the manufacturer list price ($2.90). For each patient, the actual number of antibiotic doses given was multiplied by total cost per dose. Results. There were no significant differences between antibiotic groups with respect to patient demographics, percentage with a severe wound, and mean days of i.v. therapy. Compared with piperacillin–tazobactam, patients treated with ertapenem received significantly fewer mean doses (25.5 versus 7.5; p < 0.0001) and lower antibiotic-related costs ($502.76 versus $355.55, respectively; p < 0.001). The $147.21 difference between groups accounts for approximately 3% of total hospital Medicare reimbursements for these infections. Conclusion. A CMA of treatment of diabetic foot infections showed that, compared with piperacillin–tazobactam given four times daily i.v., ertapenem given once daily i.v. was associated with lower drug acquisition and supply costs and less time and labor devoted to preparation and administration of i.v. therapy. Index terms: Antibiotics; Beta-lactamase inhibitors; Costs; Diabetic foot; Dosage schedules; Drug comparisons; Ertapenem; Penicillins; Pharmacoeconomics; Piperacillin sodium; Tazobactam sodium