Pharmacoeconomics of Aztreonam‐Clindamycin versus Gentamicin‐Clindamycin in the Treatment of Penetrating Abdominal Injury

Abstract

Study Objective. To evaluate the pharmacoeconomic implications of using aztreonam‐clindamycin (A‐C) versus gentamicin‐clindamycin (G‐C) from the perspective of the hospital and pharmacy directors.Design. Pharmacoeconomic analysis performed at one of the sites participating in the prospective, randomized, double‐blind, comparative, multicenter efficacy study.Setting. Referral hospital with level 1 trauma center.Patients. Eight‐five adults with a suspected penetrating intraabdominal injury requiring laparotomy.Interventions. Patients were randomized to receive aztreonam 2 g intravenously every 8 hours or gentamicin 2 mg/kg intravenous load followed by 5 mg/kg/day intravenously initially adjusted to peak concentrations of 6–8 μg/ml. All patients received clindamycin 900 mg intravenously every 8 hours.Measurements and Main Results. Charge data were gathered from the hospital billing system and converted to cost data using an institutional cost:charge ratio of 0.6. Study drug and aminoglycoside monitoring costs were also calculated. Overall, 43 (97%) of 44 patients receiving A‐C had a favorable clinical response compared with 35 (85.4%) of 41 receiving G‐C (p=0.052). The mean hospital cost of $66,336 for 7 infected patients was significantly higher than that of $8014 in 78 noninfected patients (p>0.0001). Mean hospital costs of $12,058 and $13,742 for A‐C and G‐C groups, respectively, were not significantly different (p<0.05) despite having only a single failure (total cost $162,666) in the A‐C group. Similarly, mean pharmacy costs of $1411 and $1604, respectively, were not significantly different (p>0.05).Conclusions. Hospital costs for infected patients with penetrating abdominal trauma exceed those of noninfected patients by 5‐fold. Despite a lower infection rate in the A‐C group, neither hospital nor pharmacy costs were significantly different compared with those in the G‐C group.