DOI: http://dx.doi.org/10.18203/issn.2454-2156.IntJSciRep20210095

Evaluation of restricted antibiotic utilization and cost-minimization analysis in a tertiary care hospital in India

Dhakchinamoorthi Krishna Kumar, Mani Swapna, Srinivasan Kanmani, Varghese Varsha, Nair V. Vidya

Abstract


Background: Antibiotic resistance is a major menace to public health and treatment of several infectious diseases, also associated with an economic burden to society.  Pharmacoeconomic analysis of antibiotic usage and cost-minimization analysis provides better and low-cost drug selection for the patients.

Methods: The study was conducted as a cross-sectional, observational analysis of restricted antibiotics in the prescriptions (n= 191). Cost minimization analysis was conducted for the restricted antibiotics alone. The drug costs of prescribed brands were compared with the least cost brands, and the percentage cost difference was calculated and compared by student paired ‘t’ test. P<0.05 considered statistical significance.  

Results: The average age of the patients was found to be 58.1±18.3 (Mean±SD) years, and most of the restricted antibiotics were prescribed for the treatment of hospital-acquired infections 71.7%. Meropenem was prescribed highly 29.8% followed by imipenem (28.8%) and colistin (12%). The major reason for starting restricted antibiotics was found to be infectious diseases (27.7%). The cost-minimization analysis showed that the total unit cost for caspofungin (₹1,85,000 or $2523.40) was found to be higher followed by meropenem (₹1,29,800) in the prescriptions. The mean cost of actually prescribed restricted antibiotics was found to be ₹68,338±61,332 (Mean±SD). The lowest mean cost of restricted antibiotics was found to be ₹32,223±31,082 (p<0.05).

Conclusions: Pharmacoeconomic cost-minimization analysis was a useful tool for clinical pharmacist in the selection of appropriate antibiotics and minimizing the burden of the cost of the drugs, it provides a better outcome in patients while using restricted antibiotics with infectious disease.


Keywords


Antimicrobial, Cost Minimization, Pharmacoeconomic, Restricted antibiotics

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References


Chandy SJ, Naik GS, Charles R, Jeyaseelan V, Naumova EN, Thomas K, et al. The impact of policy guidelines on hospital antibiotic use over a decade: a segmented time series analysis. PLoS One. 2014;9(3):e92206.

The rise of superbugs. Dangerous infections that are resistant to antibiotics are spreading and growing stronger, with dire consequences. Medical experts say it's a mess of our own making--and the clock is ticking on when and how we must solve it. The first in a three-part series. Consum Rep. 2015;80(8):20-6.

De Waele JJ, Akova M, Antonelli M, Canton R, Carlet J, De Backer D, et al. Antimicrobial resistance and antibiotic stewardship programs in the ICU: insistence and persistence in the fight against resistance. A position statement from ESICM/ESCMID/WAAAR round table on multi-drug resistance. Intensive Care Med. 2018;44(2):189-96.

Lanbeck P, Ragnarson Tennvall G, Resman F. A cost analysis of introducing an infectious disease specialist-guided antimicrobial stewardship in an area with relatively low prevalence of antimicrobial resistance. BMC Health Serv Res. 2016;16:311.

Sriram S, Aiswaria V, Cijo AE, Mohankumar T. Antibiotic sensitivity pattern and cost-effectiveness analysis of antibiotic therapy in an Indian tertiary care teaching hospital. J Res Pharm Pract. 2013;2(2):70-4.

Wang J, Dong M, Lu Y, Zhao X, Li X, Wen A. Impact of pharmacist interventions on rational prophylactic antibiotic use and cost saving in elective cesarean section. Int J Clin Pharmacol Ther. 2015;53(8):605-15.

Jayalakshmi J, Priyadharshini MS. Restricting high-end antibiotics usage - challenge accepted! J Family Med Prim Care. 2019;8(10):3292-6.

Nair M, Tripathi S, Mazumdar S, Mahajan R, Harshana A, Pereira A, et al. "Without antibiotics, I cannot treat": A qualitative study of antibiotic use in Paschim Bardhaman district of West Bengal, India. PLoS One. 2019;14(6):e0219002.

Mitchell ED, Czoski Murray C, Meads D, Minton J, Wright J, Twiddy M. Clinical and cost-effectiveness, safety and acceptability of community intravenous antibiotic service models: CIVAS systematic review. BMJ Open. 2017;7(4):e013560.

Wolkewitz M, Schumacher M, Rucker G, Harbarth S, Beyersmann J. Estimands to quantify prolonged hospital stay associated with nosocomial infections. BMC Med Res Methodol. 2019;19(1):111.

Kaye KS, Marchaim D, Chen TY, Baures T, Anderson DJ, Choi Y, et al. Effect of nosocomial bloodstream infections on mortality, length of stay, and hospital costs in older adults. J Am Geriatr Soc. 2014;62(2):306-11.

Sheng WH, Chie WC, Chen YC, Hung CC, Wang JT, Chang SC. Impact of nosocomial infections on medical costs, hospital stay, and outcome in hospitalized patients. J Formos Med Assoc. 2005;104(5):318-26.

Morales FE, Villa LA, Fernandez PB, Lopez MA, Mella S, Munoz M. Evolution of use of antibiotics of restricted prescription and trend of bacterial susceptibility in Concepcion Regional Hospital, Chile. Rev Chilena Infectol. 2012;29(5):492-8.

Saridi M, Rekleiti M, Toska A, Kriebardis AG, Tsironi M, Syrigos K, et al. Appropriate utilization of restricted antibiotics in a general hospital of a perfecture area in Greece. Curr Drug Saf. 2014;9(3):212-9.

Ayuthya SK, Matangkasombut OP, Sirinavin S, Malathum K, Sathapatayavongs B. Utilization of restricted antibiotics in a university hospital in Thailand. Southeast Asian J Trop Med Public Health. 2003;34(1):179-86.

Oppong R, Kodabuckus S. Cost-effectiveness of outpatient parenteral antibiotic therapy for children with cellulitis. Lancet Infect Dis. 2019;19(10):1041-2.

Friedlander AH, Chang TI, Aghazadehsanai N, Graves LL. Cost-effectiveness of antibiotic prophylaxis. J Am Dent Assoc. 2016;147(4):229-30.

Holmes EAF, Harris SD, Hughes A, Craine N, Hughes DA. Cost-Effectiveness Analysis of the Use of Point-of-Care C-Reactive Protein Testing to Reduce Antibiotic Prescribing in Primary Care. Antibiotics (Basel). 2018;7(4).

Grotle M, Braten LC, Brox JI, Espeland A, Zolic-Karlsson Z, Munk Killingmo R, et al. Cost-utility analysis of antibiotic treatment in patients with chronic low back pain and Modic changes: results from a randomised, placebo-controlled trial in Norway (the AIM study). BMJ Open. 2020;10(6):e035461.

Dik JW, Hendrix R, Friedrich AW, Luttjeboer J, Panday PN, Wilting KR, et al. Cost-minimization model of a multidisciplinary antibiotic stewardship team based on a successful implementation on a urology ward of an academic hospital. PLoS One. 2015;10(5):e0126106.

Lee KK, Wan MH, Fan BS, Chau MW, Lee VW. A cost-minimization analysis comparing different antibiotic regimens used in treating all-cause bacterial pneumonia in Hong Kong. J Med Econ. 2009;12(1):46-55.

Tiwari SA, Ghongane BB, Daswani BR, Dabhade SS. Restricted Parenteral Antibiotics Usage Policy in a Tertiary Care Teaching Hospital in India. J Clin Diagn Res. 2017;11(5):FC06-9.

Almulhim AS, Aldayyen A, Yenina K, Chiappini A, Khan TM. Optimization of antibiotic selection in the emergency department for urine culture follow ups, a retrospective pre-post intervention study: clinical pharmacist efforts. J Pharm Policy Pract. 2019; 12:8.

Alvaro-Alonso EA, Aldeyab M, Ashfield L, Gilmore F, Perez-Encinas M. "International Centres of Excellence in Hospital Pharmacy"; a SEFH new initiative; the role of the clinical pharmacist in the hospital antibiotic stewardship in Northern Ireland. Farm Hosp. 2016;40(4):233-6.