COST-ANALYSIS OF IMIPENEM-CILASTATIN VERSUS CLINDAMYCIN WITH TOBRAMYCIN IN THE TREATMENT OF ACUTE INTRAABDOMINAL INFECTION

Clinical effectiveness of imipenem/cilastatin (I/C) versus tobramycin with clindamycin (T + C) in treatment of patients presenting with susp ected acute intra-abdominal infection was assessed in a multicentre ra ndomised clinical trial conducted during 1985 to 1986. The principal f inding was a lower incidence of treatment failure among patients in th e I/C arm (p = 0.043). We now report results of retrospective analysis of hospital treatment costs during an episode of infection incurred b y patients enrolled in the trial. Treatment costs (in 1989 US dollars) were calculated from a hospital perspective, using an intention-to-tr eat analysis. Among 161 patients with low illness severity (APACHE II less-than-or-equal-to 14) the mean cost for the episode of care was $U S7038 in the I/C arm versus $US8404 for the T + C regimen; the differe nce was not statistically significant (p = 0.40). For 93 more severely ill patients (APACHE II score > 14) the mean cost for the I/C arm was $US19 985 versus $US16 582 for the T + C regimen; the difference was not statistically significant (p = 0.36). Multiple regression analysis , controlling for patient demographics and study site, showed that the cost of the episode was positively associated with the severity of il lness (p < 0.0 1) and presence of malnutrition (p < 0.01), but that th e total cost of the episode of infection was not statistically differe nt for the 2 drug regimens (p = 0.45).