Cost-utility analysis comparing meropenem with imipenem plus cilastatin in the treatment of severe infections in intensive care
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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.
KeywordsMeropenem Imipenem Infection Intensive care Cost-utility analysis
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:
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- 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
- 5.Anonymous (1999) National statistics. Mortality statistics: England and Wales 1999. TSO: LondonGoogle Scholar
- 6.Anonymous (2004) National statistics. Annual abstract of statistics 2004. TSO: LondonGoogle Scholar
- 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.Anonymous (2003) British national formulary. British Medical Association and Royal Pharmaceutical Society of Great Britain: LondonGoogle Scholar
- 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
- 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.Plumridge RJ (1997) Cost analysis of infusion versus injection delivery of imipenem/cilastatin and meropenem. Clin Drug Invest 14:132–136Google Scholar