Article Text

Download PDFPDF

4CPS-045 Cost effectiveness analysis of meropenem dose optimisation in critical patients
  1. AI Idoate,
  2. A Aldaz,
  3. I Aquerreta,
  4. A Ortega
  1. Clinica Universidad De Navarra, Pharmacy, Pamplona, Spain


Background and importance Meropenem dose adjustment following pharmacokinetic/pharmacodynamic monitoring (TDM) in critical patients (CP) presents a clinical benefit. An economic analysis of this activity could facilitate its use in clinical practice.

Aim and objectives To conduct a cost effectiveness analysis of meropenem TDM in CP versus standard dose (SD) according to the package insert recommendations.

Material and methods We conducted a naturalistic, retrospective, observational cohort study of CP receiving meropenem between May 2011 and December 2017 in a university hospital. Two cohorts were analysed: patients with meropenem TDM (cohort A) and patients with SD meropenem (cohort B).

The main effectiveness variable was the percentage of patients with a reduction of at least 80% in the procalcitonin value at the end of meropenem treatment compared with the maximum value during meropenem treatment.

Costs included in the analysis were: meropenem, material for drug preparation, TDM, time for preparation, administration and infusion surveillance, meropenem adverse drug reactions (ADR), critical care hospitalisation days and re-entries.

Propensity score (PS) matching was applied for patient selection. The χ2 was used to compare effectiveness and bootstrap to calculate the difference in costs between cohorts. A cost effectiveness analysis with deterministic and probabilistic sensitivity analyses was performed.

Results A total of 154 patients were included (77 per cohort) after PS matching. Meropenem dose was changed in 51 (66.2%) patients with TDM, in most (90.2%) because they were overdosed. In cohort A, 71.4% of patients had reduced procalcitonin by at least 80% compared with 53.2% in cohort B (difference 18.2% (95% CI 3.1; 33.2; p=0.020)). No significant differences were found in ADR between the two cohorts. An average decrease in cost per patient of −1454€ (95% CI −4627;1720€) with TDM was observed, with lower cost per patient for meropenem −62€ (95% CI −116; −4), disposable material −12€ (95% CI −29; 4) and nursing time −38€ (95% CI −71; −4) in cohort A, that offset the TDM cost (47€). Mean hospitalisation cost in patients with TDM was 8912€ versus 10 325€ in cohort B. There was a 75% probability that TDM was more effective and cheaper (dominant) than SD according to the sensitivity analysis.

Conclusion and relevance Meropenem dose adjustment following pharmacokinetic/pharmacodynamic criteria was more effective, with similar safety and lower costs, than dosing according to the package insert recommendations.

References and/or acknowledgements 1. Schuetz P, et al. Procalcitonin-guided antibiotic stewardship. Clin Chem Lab Med 2019.

No conflict of interest.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.