A Pharmacoeconomic Study Of Cefoperazone/sulbactam With Levofloxacim Compared With Imipenem/cilastatin For The Treatment Of Lower Respiratory Tract Infections

Objective: To conduct a cost-minimization analysis of cefoperazone/sulbactam with levofloxacin vs imipenem/cilastatin in the treatment of patients hospitalized with mediated or severe lower respiratory tract infections.Methods: 51 patients were enrolled into a prospective, randomized, open-label clinical trial of adults, 25 patients received cefoperazone/sulbactam with levofloxacin, 26 patients received imipenem/cilastatin. Cefoperazone/sulbactam was administrated 2.0g, bid, levofloxacin was administrated 0.3g, qd, imipenem/cilastatin was administrated 0.5g, q8h. The course of therapy was 7~14 day. A phamacoeconomic analysis from the society perspective was conducted. Health-care resource utilization was extracted from the clinical recordes. Sensitivity analyses were performed to test the robustness of economic findings. Date collected included patient demographics, clinical and microbiological outcomes, and the course of therapy. Costs evaluated include drug acquisition (level 1); plus costs of preparation, dispensing, and administration (level 2); plus hospital costs (level 3); plus the indirect cost (level4).Results: The clinical success and the course of therapy were 48.0%, 9(QR=5.5) days for the cefoperazone/sulbactam with levofloxacin group and 50.0%, 8.5(QR=7) days for the group receiving imipenem/cilastatin, respectively (P>0.05). The mean treatment costs per patient (level4) were $9874.97±3477.67 for the cefoperazone/sulbactam with levofloxacin group, and $10838.74±3881.75 for the group receiving imipenem/cilastatin. When the course of therapy were controlled, the different costs between two groups on 4 levels were significant (P﹤0.01). The costs of the group receiving imipenem/cilastatin were always higher than the group receiving cefoperazone/sulbactam with levofloxacin. Sensitivity analyses revealed that the results were not sensitive to changes in the cost of level 4.Conclusions: Based on the results of the clinical trail, cefoperazone/sulbactam with levofloxacin and imipenem/cilastatin offer similar clinical, microbiologic, and toxicity outcomes in hospitalized patients with lower respiratory tract infections. Cefoperazone/sulbactam with levofloxacin provides an economic advantage compared to the regimen of imipenem/cilastatin.