, Volume 18, Issue 4, pp 369–381 | Cite as

Cost Effectiveness of Cephalosporin Monotherapy and Aminoglycoside/Ureidopenicillin Combination Therapy

For the Treatment of Febrile Episodes in Neutropenic Patients
  • Joseph A. PaladinoEmail author
  • Debra A. Fong
  • Alan Forrest
  • Reuben Ramphal
Original Research Article


Objective: To assess the relative cost effectiveness of cephalosporin monotherapy options and aminoglycoside/ureidopenicillin combination therapy for the treatment of febrile episodes in adult patients with neutropenia.

Design and setting: This was a retrospective cost-effectiveness analysis conducted from the institutional perspective.

Methods: The analysis was based on 741 febrile episodes in adult patients with neutropenia enrolled in 5 randomised trials: 3 comparing monotherapy with ceftazidime or cefepime, and 2 comparing cefepime monotherapy versus aminoglycoside/ ureidopenicillin combination therapy. Resource utilisation included costs for study antibacterials, treatment of adverse effects and failures, and hospitalisation. The primary end-point was the overall cost of treatment per patient. Cost-effectiveness ratios were also analysed.

Results: No significant differences in clinical success rates were detected. Median per-patient costs in the monotherapy comparisons were $US7849 for cefepime and $US7788 for ceftazidime [1997 values; not significantly different (NS)]. Corresponding costs for the monotherapy versus combination therapy comparisons were $US9780 for cefepime and $US10 159 for gentamicin/ureidopenicillin (NS). Despite a higher acquisition cost for cefepime, there were no statistically significant differences in cost effectiveness compared with either ceftazidime monotherapy or gentamicin/ureidopenicillin combination therapy. Sensitivity analyses revealed that monotherapy can be cost effective compared with combination therapy in many situations.

Conclusion: There were no economic differences between the 3 regimens tested. Therefore, drug cost should not be a deciding factor when choosing antibacterial therapy for the treatment of febrile episodes in adult patients with neutropenia.


Ceftazidime Cefepime Febrile Episode Clinical Success Rate Mezlocillin 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



The authors thank Lynn Jagodzinski for her technical assistance. This work was funded in part by an unrestricted grant from Bristol-Myers Squibb Company.


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Copyright information

© Adis International Limited 2000

Authors and Affiliations

  • Joseph A. Paladino
    • 1
    Email author
  • Debra A. Fong
    • 1
  • Alan Forrest
    • 1
  • Reuben Ramphal
    • 2
  1. 1.The Clinical Pharmacokinetics LaboratoryMillard Fillmore Suburban Hospitals, Kaleida Health, and the State University of New York at BuffaloBuffaloUSA
  2. 2.The University of FloridaGainesvilleUSA

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