PCN20: COST MINIMIZATION ANALYSIS OF CEFEPIME VERSUS IMIPENEM-CILASTATINE IN CANCER PATIENTS WITH SHORT-DURATION FEBRILE NEUTROPENIA

Abstract

OBJECTIVE: To perform pharmacoeconomical comparison of cefepime versus imipenem-cilastatine used for empiric therapy in cancer patients with short-duration febrile neutropenia in Russia. METHODS: The decision tree was designed to analyse the costs and outcomes of studied treatment. Probabilities of clinical success, adverse events, switching to a new drug and adding extra antibiotics were extracted from a published multicentral randomised clinical trial. Firstly the study was planned to be a cost-effectiveness analysis, but data obtained from the trial, demonstrated equal efficacy of both drugs. So finally the study was performed as cost-minimization analysis. The following costs were taken into account: the drug acquisition price, drug preparation and administration, medications to treat failures and adverse events, including antibiotics added to main medication. Schemes of treatment for adverse events and choice of antibiotics for treating clinical failures typical for clinical practice in this country were obtained from expert panel. Costs of drugs were derived from official price-lists of pharmacies. Hospital costs were excluded, as there was no difference in the length of treatment between the groups according to the results of the trial. RESULTS: According to clinical trial the probability of clinical success for short-duration febrile neutropenia treatment in cancer patients is equal in both drugs (79 % for cefepime and 72% for imipenem, equivalence, p < 0.0001). Cost of treatment of 1 patient with imipenem-cilastatine including added antibiotics, drugs for treating failures and adverse events was 21 207,2 roubles (757,4 USD), for cefepime?10 512, 32 roubles (375,44 USD). CONCLUSION: Cefepime monotherapy being clinically as effective as imipenem-cilastatine is twice less costly for the empirical treatment of fever in short-duration neutropenia. Changing of widely recommended for empiric therapy of febrile neutropenia imipenem-cilastatine for cefepime will save 10 694,88 roubles (382 USD) in each treated patient.