ASSESSING COST-EFFECTIVENESS OF ANTIMICROBIAL TREATMENT - MONOTHERAPYCOMPARED WITH COMBINATION THERAPY

The obvious costs of antibiotic treatment include drugs, equipment wit h which to give them, and assays. Less obvious, but more important, ar e the costs of quality control to ensure safe and effective treatment. The more complex the regimen, the more expensive the quality control. None the less, there is considerable variation in both assay price an d number of assays/patient. Our data show that the drug costs of a reg imen such as ampicillin plus gentamicin plus metronidazole are outweig hed by the costs of quality assurance to prevent drug toxicity and cha rges of malpractice. Trials show that monotherapy with various beta-la ctams is more cost effective than aminoglycoside combinations for surg ical infections. Compounds such as piperacillin/tazobactam, a new beta -lactam/beta-lactamase inhibitor combination that is classed as monoth erapy, have the potential to solve many of these economic problems. Se veral completed and continuing clinical studies are showing that monot herapy is as effective as combination treatment. Cost studies in the f uture are likely to confirm the economic advantages of monotherapy.