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Potential for Cost Saving with Iclaprim Owing to Avoidance of Vancomycin-Associated Acute Kidney Injury in Hospitalized Patients with Acute Bacterial Skin and Skin Structure Infections

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Abstract

Background and Objective

Vancomycin is the most prescribed antibiotic for hospitalized adults with skin and skin structure infections. Vancomycin is associated with acute kidney injury. Iclaprim is an antibiotic under development for the treatment of patients with acute bacterial skin and skin structure infections and is not associated with acute kidney injury. This economic model sought to determine the potential cost saving with iclaprim owing to avoidance of vancomycin-associated acute kidney injury among hospitalized patients with acute bacterial skin and skin structure infections.

Materials and Methods

A hospital cost-minimization model was developed to estimate the overall cost impact of replacing empiric vancomycin with iclaprim among hospitalized adult patients with skin and skin structure infections. The structural model included: vancomycin acquisition; vancomycin assay; incidence of vancomycin-associated acute kidney injury; excess hospital length of stay if acute kidney injury occurred; frequency/cost of specialty physician consults after occurrence of acute kidney injury; and probability/cost of acute dialysis as a result of acute kidney injury. Iclaprim treatment duration was 7 days and iclaprim acquisition cost was varied to determine the upper end of the daily iclaprim price that still conferred cost savings relative to vancomycin. Duration of hospitalization for iclaprim was assumed to be the same as patients with no acute kidney injury.

Results

Based on the overall acute kidney injury rate (9.2%), the neutral acquisition price threshold for iclaprim vs. vancomycin was US$1373.47/regimen. Across various subpopulations where acute kidney injury risk ranged between 9.2 and 16.7%, the daily iclaprim acquisition cost that still conferred cost savings was up to US$300/day.

Conclusions

Iclaprim has the potential to reduce the economic burden of acute bacterial skin and skin structure infections in hospitalized patients at risk for vancomycin-associated acute kidney injury when iclaprim acquisition is US$300/day or less.

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Authors and Affiliations

  1. Pharmacy Practice, Albany College of Pharmacy and Health Sciences, 106 New Scotland Ave, Albany, NY, 12208-3492, USA

    Nimish Patel & Thomas Lodise

  2. Motif BioSciences, Inc., 125 Park Avenue, 25th Floor, New York, NY, 10017, USA

    David Huang

  3. IDRx Solutions LLC, 11 Mohagany Drive, Albany, NY, 12208, USA

    Thomas Lodise

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  1. Nimish Patel
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Correspondence to Thomas Lodise.

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Funding

Motif BioSciences sponsored work performed by IDRx Solutions LLC to derive the data presented in this article.

Conflict of interest

Nimish Patel and Thomas Lodise have received investigator-initiated research grant support from Motif BioSciences, Inc. David Huang is a paid employee of Motif BioSciences, Inc. Thomas Lodise has received consulting honoraria from Motif BioSciences, Inc.

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Patel, N., Huang, D. & Lodise, T. Potential for Cost Saving with Iclaprim Owing to Avoidance of Vancomycin-Associated Acute Kidney Injury in Hospitalized Patients with Acute Bacterial Skin and Skin Structure Infections. Clin Drug Investig 38, 935–943 (2018). https://doi.org/10.1007/s40261-018-0686-5

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