1. Stevce Acevski PhD Alkaloid AD ISPOR Macedonia
COST OF ILLNESS Antibiotic treatment of nosocomial infection`s from Methicillin resistant Staphylococcus aureus (MRSA), Acinetobacter sp. or Pseudomonas aeruginosa
Stevce Acevski PhD
Alkaloid AD
ISPOR Macedonia

2. Introduction
Pharmacoeconomic researches are identifying, measuring and comparing costs and outcomes from therapy in healthcare systems and in society
They are common criteria`s for making decision in health policies
Nowadays all developed countries base their decision making on various pharmacoeconomic analyses, in order to make wise and fruitful decisions, regarding costs and outcomes in the healthcare system

3. No of patient`s – Period: 2014 – 2015
University children's hospital
Clinic of infectious diseases
Nephrology
ICU
Abdominal surgery
Total
31 489
Others

4. Identified infections
Bacteria/Institution
Clinics of infectious diseases
Abdominal surgery
TOTAL
Methicillin resistant Staphylococcus aureus (MRSA) 8 6 14
Acinetobacter sp. 26 19 45
Pseudomonas aeruginosa 28 56 62 53
115

5. Registered nosocomial infections
Clinic of infectious diseases
Abdominal surgery
Percentage registered / identified
Clinic of infectious diseases
Abdominal surgery
28 %
47 %

6. Gender / Treatment outcome16
38,1 % 26
61,9 %
Cured
Death

7. Days of treatment 78 45 31
Patient`s

8. Prevalence Country Year Prevalence (%) Switzerland 1996 11,6 Spain
1990
9,9
Great Britain
11,2
France
7,6
Italy
1983 / 2001 / 2000
6,8 / 8,3 / 7,8
Germany
1994
3,5
Slovenia
2001
5,0
Macedonia
0,7 - 6,8

9. Bacterial resistance Bacteria % of total resistance
Methicillin resistant Staphylococcus aureus (MRSA)
49,4 %
Acinetobacter sp.
87,4 %
Pseudomonas aeruginosa
49,3 %

10. Cost of the treatment
When deciding which antibiotic treatment to start, antibiotic`s choice is one way to reduce total financial cost for the treatment
Protocols for specific infections, can give directions which antibiotic to choose

11. Sanford guide for antimicrobial therapy

12. Direct / Indirect costs
Cost factors in hospitalized patients
Direct costs
Cost of the treatment
(cost pro doses or daily therapy costs)
Indirect costs
Cost for I.V. administration
Cost for follow up and evaluation of the patient
Cost for emerged antibiotic resistance and failure of the treatment connected with antimicrobial resistance
Cost for adverse reactions from the therapy
Cost for therapeutic failure
(e.g. prolonged treatment or retreatment with other antibiotic)

13. COI – cost of illness Days of treatment Cost of treatment Еур One ATB
One ATB
More ATB
Mean
5 - 14
8,4 ± 2,7
3 - 78
15,1 ± 14,2
30, ,8
121,13
8, ,3
407,3
Observations 10 32
t Statistical
t Critical two-tail
t Stat > t Critical two-tail, α= 0,05

14. COI – monotherapy vs poly therapy
> 86,7 %
Treatment with one antibiotic
Treatment with more antibiotic`s

15. ICER cost vs days of treatment monotherapy vs poly therapy
Cost of treatment (EUR)
Days of treatment

16. Sensitivity analysis

17. Cost of the treatment Other factors: Basic infection
Efficacy of the drug
Adverse reactions of the treatment
Compliance
Availability of health resources
Health insurance of the patient
Possibility of the patient to take care of himself
Costs connected with intravenous administration
Availability of/for PO therapy
Cost of therapeutic failure

19. Conclusion 1/3
Average cost for therapy of nosocomial infections with one antibiotic is 121,13 EUR, per patient
Average cost of treatment with more antibiotic agents 407,3 EUR, per patient
COI – cost of illness

20. Conclusion 2/3 Incremental cost effectiveness ratio (ICER) 42,72

21. Conclusion 3/3 CMA – cost minimization analysis
Cost of treatment of patients with nosocomial infections with more antibiotic is higher for 86,7 %
CMA – cost minimization analysis

22. Recommendations

23. Recommendations 1/3
Main factor in evaluation of antimicrobial agents used in treatment of nosocomial infections is patient
Evaluation of economic factors is main step when deciding and use of antimicrobial therapy
Factors that are evaluated are multiple, complex, interconnected and changeable with time

24. Recommendations 2/3
Make evaluation of the patient with possible infection
Start aggressive antibiotic treatment, in time adjust it as you get clinical and laboratory data
Observe data for antimicrobial resistance, so you could make proper antibiotic use

25. Recommendations 3/3
Make continuously cost effectiveness evaluations so you could follow costs for nosocomial infections treatment

26. THANK YOU FOR YOUR ATTENTION