Analysis And Pharmacoeconomics Evaluation On Therapeutic Drug Monitoring Of Vancomycin

Objectives1.Analyze the clinical application of vancomycin,aiming to provide references for the rational and effective use of vancomycin.2.Analyze the situation of vancomycin therapeutic drug monitoring,clarify the relationship between clinical efficacy and adverse reactions,to put forward strategies to improve clinical pharmacy service.3.Provide the economic evidence for clinical individualized drug regimen,by conducting an economic evaluation of real world vancomycin therapeutic drug monitoring,further promote rational drug use and optimize clinical pharmacy service strategies.Methods1.According to the assessment standard,the clinical records of inpatients treated with vancomycin in a hospital during January 1,2018 to December 31,2018 were retrospectively investigated,and the rational drug use was evaluated.2.Guidelines for therapeutic drug monitoring of vancomycin were electronically retrieved in databases and evaluated by AGREEⅡ.Enrolled patients in part 1 were divided into TDM group or control group according to whether they were conducted TDM.The monitoring status of drug concentration in the two groups was analyzed and evaluated based on the established evaluation criteria.3.The patients who were in the rational use of drugs and guided by TDM guildline were included.Propensity score matching was used to balance the differences of patients’basic characteristics between the TDM group and the control group.Decision tree model was used to evaluate the cost and outcome of TDM.Results1.945 cases were derived from 27 departments,involving patients aged from 16days to 90 years old,mainly from the department of hematology（47.1%）and with respiratory system infection being the most common infection site.Gram positive bacteria were detected in 284 cases.DUI=0.83,CDUI=0.93,the treatment effective rate was 69.3%,the incidence of adverse drug reaction was 14.2%,and 8.0%of cases were not rational.2.Four guidelines were included which involved 2 from China,1 from United States and 1 from Japan.Six areas of AGREEⅡscored an average of 82.7%,54.9%,56.6%,91.0%,28.1%and 47.9%.A guideline with the highest scores was selected to establish nine evaluation standards.283 patients were conducted TDM 470 times,the monitoring rate was 29.9%,1.6 times per patient.117 patients underwent dose adjustment.662 patients were not monitored,in which 319 of them should and were recommended TDM by the guideline.67 cases fulfilled the recommended first blood drawing time by the guidelines,and in 48 cases the blood concentration was within the range of 10-15 mg.L^-1.3.There were 66 and 625 patients in the TDM group and the control group before PSM.After PSM,106 patients were included,with 53 patients in each two groups without heterogeneity at baseline.The cost of TDM group was CNY6,844.42,the cost of control group was CNY7,664.96,and the incremental cost was CNY820.54.The overall effective rates of the two groups were 67.9%and 52.8%,respectively.TDM was the dominant strategy,and the conclusion is stable to the sensitivity analysis,which is not affected by the changes of various factors.Conclusions1.Vancomycin was widely used throughout the departments in this hospital,and there was a general situation of combined drug use.The clinical application of vancomycin was generally rational but there were still inappropriate phenomena in the clinical use process.The rational use of vancomycin should be strengthened in the regulation.2.The overall quality of guidelines for vancomycin TDM was inconsistent and the guideline from China published in 2015 has the best scores.There was a discrepancy between the monitoring situation of vancomycin TDM and the guideline recommendations,including the low testing rate of patients who should be monitored,the inappropriate monitoring time of blood collection,and the failure to adjust the dose timely according to the monitoring results.Clinical pharmacists should justify the clinical needs and implement the clinical pharmacy service of individualized medication for patients based on TDM.3.This retrospective TDM economics research achieved baseline comparability thanks to the PSM method.The data were collected from routine clinical monitoring,hence could objectively reflect the real-world situation of clinical practice.Based on the decision tree model,vancomycin TDM had good therapeutic effect,lower cost and economic efficiency.The analysis results need to be further verified by expanding the sample size.