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A Journal on Internal Medicine

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Minerva Medica 2010 August;101(4):195-204

language: Italian

Assessment of tigeycline use economic impact in first-line therapy for complicated intra-abdominal infections in an Intensive Care Unit

Ancona F.

Partner PricewaterhouseCoopers Advisory SpA, Industry Pharma, Milano, Italia


The aim of this study was to determine the economic impact on hospital budget expenditure for two different prescribing practices: use of tigecyline in second or first-line therapy (when appropriate). This empirical study was carried out at the Intensive Care Unit (ICU) (Chief, Dr. Alberto Costantini), Ospedali Riuniti, Ancona. Cost determination was based on health care processes as revealed by field survey at the ICU. Mapping of the health care processes was neither derived from official protocols nor from an ex-post analysis of medical records but rather directly from descriptions of the processes as referred by the ICU physicians and health care staff, and then summarized in flow charts and approved by the ICU chief. The assumption was that tigecycline, because of its broader spectrum of action, would more probably clear infections when used in the first course of antibiotic therapy. Notwithstanding this advantage, tigecycline has a higher daily dose cost than first-line antibiotics. This study compared the higher costs incurred by the use of tigecycline as a first-line antibiotic versus potential savings obtained with such use, also in view of the prevention of possible treatment failures and the additional cost of administering a second course of antibiotic therapy, wherein the result would depend on the number of preventable treatment failures. The analysis concludes with a discussion and graphic illustrations comparing the differential probable treatment success which would render the two treatment alternatives economically indifferent.

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