A review of the health economic and resource utilization literature for the use of tigecycline treatment of complicated intra-abdominal infections

Abstract

Objectives:Complicated intra-abdominal infections (cIAIs) infect deep soft tissues requiring surgical interventions and often result in decreased quality of life due to hospitalization. In addition to tigecycline, treatment of cIAI includes other drugs such as ceftriaxone, ciprofloxacin, imipenem, and levofloxacin. In this study, we conducted a literature review using publically-available databases focusing on the health economic and resource utilization estimates of tigecycline and the other agents as first-line treatment of cIAIs. Methods:The databases used in this systematic review included PubMed and 42 unique HTA organizations. Search terms included “tigecycline” in combination with “Health Economics,” “Resource Utilization,” “Cost-Effectiveness,” and “Length of Stay.” The search criteria excluded articles with the following characteristics: without abstracts, published over 10 years ago, or not in English. Articles were then determined for eligibility using four additional inclusion criteria: 1) Indication, 2) Bacteria Type, 3) Qualitative Assessment, 4) Technicality. Studies were analyzed independently and not pooled because this was not a meta-analysis. Results:After applying our filters to the search criteria, we identified 9 unique papers on the health economics and resource utilization of using tigecycline as first-line treatment of cIAIs. Though the health economic search resulted in only a few number papers on the cost-effectiveness of tigecycline, the messaging was consistent: tigecycline showed competitive clinical effectiveness and economic resource utilization versus several different comparators despite higher acquisition expenses. Several studies established that in terms of length of stay (LoS), total costs of hospitalization and other resource utilization parameters tigecycline was not inferior and thus the results do not favor one treatment over another.Conclusion:The health economics literature estimates tigecycline to have comparable total cost per patient with respect to comparators. The broad spectrum activity of the drug avoids inappropriate treatments which are associated with increased resource utilization and result in higher costs. In view of the alarming spread in antibiotic resistance, the addition of another treatment option offers a valuable tool to counteract a mono-culture of therapies applied against cIAIs.