Decision analysis modelling of costs and outcomes following cefepime monotherapy in Canada

Objective: To evaluate the comparative cost of treatment and intermediate outcomes (percentage resistant organisms, days in hospital, etc) among cefepime and alternative parenteral antibiotics used for empiric monotherapy. Design: Decision analysis model, based on published literature, clinical trial results and information from infectious disease clinicians. Setting: A Canadian tertiary care hospital. Intervention: Comparison of cefepime, ceftazidime, ceftriaxone, cefotaxime and ciprofloxacin in the treatment of lower respiratory tract infections, urinary tract infections, skin/soft tissue infections, septicemia and febrile neutropenia. Main results: Cefepime treatment results in the lowest average cost per patient when used as initial empiric therapy for lower respiratory tract infections and for skin/soft tissue infections. Cefepime therapy is among the lowest cost treatments for the other infectious disease conditions and has the lowest cost for a weighted 'average' condition. Sensitivity analysis indicates that model results are most sensitive to duration of hospitalization. Conclusions: Initial empiric monotherapy with cefepime for serious infectious disease conditions may result in cost savings compared with alternative parenteral agents.