Objectives:
To elicit actual clinical practice of treating intensive care unit
patients with catheter-related infections with teicoplanin or vancomycin
from a hospital perspective. As clinical trials have demonstrated
similar efficacy of these glycopeptides, a cost-minimisation analysis
was also carried out.
Methods: The Delphi survey technique was used to gather the opinion
of nine physicians regarding resource utilization associated with
teicoplanin and vancomycin. Treatment costs considered were costs
of drug acquisition, costs of material and nursing time required
for drug preparation and administration, and costs of laboratory
tests.
Results: Physicians tend to administer higher loading doses of teicoplanin
than recommended in the drug information leaflet. Even though evidence
of the effectiveness of vancomycin is mainly derived from trials
using multiple-daily administration schedules, five physicians administered
it on a once-daily basis. Mean treatment costs amounted to 1,272€
with teicoplanin and 1,041€ with vancomycin. Higher treatment costs
with teicoplanin arose from more elevated drug acquisition costs
(1,076€ versus 795€). Treatment with vancomycin was associated with
higher costs of laboratory tests as a result of more frequent monitoring
of serum concentrations (217€ versus 150€).
Conclusions: This analysis of clinical practice and costs indicated
that the resource utilisation advantages from fewer laboratory tests
with teicoplanin partially offset higher drug acquisition costs.
In addition to efficacy and costs, other factors such as route of
administration, patient profile and adverse effects need to inform
the choice between teicoplanin and vancomycin.
