Cost analysis of 2 empiric antibacterial regimens containing glycopeptidesfor the treatment of febrile neutropenia in patients with acute leukaemia

Objective: Patients with cancer-associated neutropenia are at high risk of developing severe infections which can be fatal if treatment is not promptl y administered. For this reason, fever is treated as soon as possible with broad spectrum antibacterial therapy. The objective of this study was to co nduct a cost analysis in Italy comparing 2 empiric glycoprotein-containing antibacterial regimens for the treatment of febrile neutropenia in patients with acute leukaemia. Design and setting: A retrospective cost analysis was conducted, using the records of 527 febrile neutropenic patients with acute leukaemia who partic ipated in an 18-month multicentre (29 Italian haematological units) randomi sed trial during 1991. All patients received either of the following 2 empi ric intravenous regimens, each containing 3 antibacterial agents: ceftazidi me (2g, 3 times daily) and amikacin (15 mg/kg/day, in 3 separate doses) plu s teicoplanin (6 mg/kg, in a single dose) or vancomycin (30 mg/kg/day, in 2 separate doses). Economic analyses were carried out from a hospital perspe ctive. Only the direct costs per patient, i.e. mean antibacterial treatment and management cost, mean overall treatment failure cost and mean cost of adverse effects, were included. Main outcome measures and results: No differences were found in the clinica l response, defined as the improvement in the rate of fever or infection (i f documented), between the 2 regimens. However, tolerability, defined as th e incidence of adverse effects probably or definitely related to the assign ed treatment, was reported to be better with the teicoplanin- rather than t he vancomycin-containing regimen. Conclusions: This retrospective cost analysis showed that despite the highe r acquisition cost of teicoplanin relative to vancomycin, the lower inciden ce of adverse effects associated with teicoplanin and its ease of administr ation (single daily dose) resulted in equivalent overall treatment costs be tween teicoplanin- and vancomycin-containing regimens.