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The European Journal of Health Economics

, Volume 7, Issue 1, pp 72–78 | Cite as

Cost-utility analysis comparing meropenem with imipenem plus cilastatin in the treatment of severe infections in intensive care

  • Steven J. EdwardsEmail author
  • Helen E. Campbell
  • Jonathan M. Plumb
Original Papers

Abstract

This study compared the cost-effectiveness of meropenem with that of imipenem plus cilastatin in the treatment of severe infections in hospital intensive care in the UK. A Markov model was constructed to model lifetime costs and quality-adjusted life years (QALYs) of using meropenem and imipenem plus cilastatin for the treatment of severe infections in intensive care. Estimates of effectiveness, utility weights and costs were obtained from the published literature. Probabilistic sensitivity analysis was conducted to assess the robustness of the results. Estimated treatment costs for the patient cohort were £14,938 with meropenem and £15,585 with imipenem plus cilastatin. QALYs gained were 7,495 with meropenem and 7,413 with imipenem plus cilastatin. Probabilistic sensitivity analysis showed meropenem to be significantly less costly (−£636.47, 95% CI −£132.33 to–£1,140.62) and more effective (0.084, 95% CI 0.023 to 0.144). Meropenem thus appears significantly more effective and less expensive than imipenem plus cilastatin and should therefore be considered the dominant treatment strategy.

Keywords

Meropenem Imipenem Infection Intensive care Cost-utility analysis 

Notes

Acknowledgements

The authors thank the following for helping develop the treatment algorithm and sense check the data used in the model: Dr. Stephen Dean (Clinical Director, St James’ University Hospital), Dr. Jeremy Sizer (Consultant Anaesthetist, Bedford Hospital), Dr. Christopher Garrard (Medical Director, John Radcliffe Hospital), and Dr. Richard Marsh, (Consultant Anaesthetist and& Lead Clinician for Critical Care, Northampton General Infirmary).

Conflict of interest:

No information supplied

References

  1. 1.
    Edwards SJ, Emmas CE, Campbell HE (2005) Systematic review comparing meropenem with imipenem plus cilastatin in the treatment of severe infections. Curr Med Res Opin 21:785–794CrossRefPubMedGoogle Scholar
  2. 2.
    Wright JC, Plenderleith L, Ridley SA (2000) Long-term survival following intensive care: subgroup analysis and comparison with the general population. Anaesthesia 58:637–642CrossRefGoogle Scholar
  3. 3.
    Garau J, Blanquer J, Cobo L, Corcia S, Daguerre M, de Latorre FJ, Leon C, Del Nogal F, Net A, Rello J (1997) Prospective, randomised, multicentre study of meropenem versus imipenem/cilastatin as empiric monotherapy in severe nosocomial infections. Eur J Clin Microbiol Infect Dis 16:789–796CrossRefPubMedGoogle Scholar
  4. 4.
    Rosenberg AL, Watts C (2000) Patients readmitted to ICUs: a systematic review of risk factors and outcomes. Chest 118:492–502CrossRefPubMedGoogle Scholar
  5. 5.
    Anonymous (1999) National statistics. Mortality statistics: England and Wales 1999. TSO: LondonGoogle Scholar
  6. 6.
    Anonymous (2004) National statistics. Annual abstract of statistics 2004. TSO: LondonGoogle Scholar
  7. 7.
    Anonymous (2004) NHS reference costs 2003 and national tariff 2004. Payment by results. Core tools. Available at: http://www.dh.gov.uk/PublicationsAndStatistics/Publications/PublicationsPolicyAndGuidan ce/PublicationsPolicyAndGuidanceArticle/fs/en?CONTENT_ID=4070195&chk=UzhHA3
  8. 8.
    Anonymous (2003) British national formulary. British Medical Association and Royal Pharmaceutical Society of Great Britain: LondonGoogle Scholar
  9. 9.
    Kerridge RK, Glasziou PP, Hillman KM (1995) The use of “quality-adjusted life years” (QALYs) to evaluate treatment in intensive care. Anaesth Intensive Care 23:322–331PubMedGoogle Scholar
  10. 10.
    National Institute for Clinical Excellence (2004) Technology appraisals process: guide to the methods of technology appraisal. Available at:http://www.nice.org.uk/page.aspx?o=201973
  11. 11.
    Briggs AH, Goeree R, Blackhouse G, O’Brien BJ (2002) Probabilistic analysis of cost-effectiveness models: choosing between treatment strategies for gastroesophageal reflux disease. Med Decis Making 22:290–308CrossRefPubMedGoogle Scholar
  12. 12.
    Rawlins MD, Culyer AJ (2004) National Institute for Clinical Excellence and its value judgments. BMJ 329:224–227CrossRefPubMedGoogle Scholar
  13. 13.
    Smyth ETM, Barr JG, Hogg GM (1996) An assessment of hidden costs on total prescribing costs of courses of meropenem and imipenem/cilastatin. Br J Med Econ 10:325–340Google Scholar
  14. 14.
    Plumridge RJ (1997) Cost analysis of infusion versus injection delivery of imipenem/cilastatin and meropenem. Clin Drug Invest 14:132–136Google Scholar
  15. 15.
    Attanasio E, Russo P, Carunchio G, Basoli A, Caprino L (2000) Cost-effectiveness study of imipenem/cilastatin versus meropenem in intra-abdominal infections. Dig Surg 17:164–172CrossRefPubMedGoogle Scholar
  16. 16.
    Basoli A, Meli EZ, Mazzocchi P, Speranza V (1997) Imipenem/cilastatin (1.5 mg daily) versus meropenem (3 g daily) in patients with intra-abdominal infections: results of a prospective, randomised, multicentre trial. Scand J Infect Dis 29:503–508PubMedGoogle Scholar

Copyright information

© Springer Medizin Verlag 2006

Authors and Affiliations

  • Steven J. Edwards
    • 1
    • 3
    Email author
  • Helen E. Campbell
    • 2
  • Jonathan M. Plumb
    • 1
  1. 1.AstraZeneca UK LtdLutonUK
  2. 2.Health Economic Research CentreUniversity of OxfordUK
  3. 3.Outcomes ResearchAstraZeneca UK LtdLutonUK

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