Clinical Response and Hospital Costs of Therapeutic Drug Monitoring for Vancomycin in Elderly Patients.

Yun Kim,Soohyun Kim,Howard Lee,Jinsook Park

doi:10.3390/jpm12020163

Abstract

Cost-effectiveness analysis has been widely used to assess and compare the costs and benefits of a clinical service. The cost-effectiveness of vancomycin therapeutic drug monitoring (TDM) has not been studied in the elderly, who are susceptible to vancomycin-induced adverse effects. This study was performed to evaluate if vancomycin TDM is cost-effective in elderly patients in the Republic of Korea. Using the electronic medical records at a tertiary university hospital, we performed a retrospective observational study to evaluate the cost-effectiveness of vancomycin TDM in 850 elderly patients who underwent vancomycin TDM with an appropriate, recommended dosing regimen and 1094 elderly patients who did not. Cost-effectiveness variables such as clinical outcomes and medical expenses were evaluated using univariate and multivariate analyses. The TDM group spent significantly less than the non-TDM group per patient for total medical expenses (by USD 841.40) and medication expenses (by USD 16.70). However, no significant difference was noted between the TDM and non-TDM groups in clinical outcomes such as microbiological cure, prevention of nephrotoxicity, or reduced mortality, irrespective of admission to the intensive care unit. Vancomycin TDM in elderly patients was associated with economic benefits, but not with better clinical outcomes.

Highlights

Therapeutic drug monitoring (TDM) has played a significant role in individualized pharmacotherapy as TDM services have become readily available in many hospitals [1,2]
As we have shown in this study, this research reported that vancomycin TDM did not result in better microbiological cure, shorter duration of vancomycin treatment, or reduced nephrotoxicity [39]
This study suggests that optimizing vancomycin therapy with appropriate TDM and pharmacokinetic consultation can avoid under-dosing, which contributes to the emergence of vancomycin resistance; it does not always lead to clinical effectiveness

Summary

Introduction

Therapeutic drug monitoring (TDM) has played a significant role in individualized pharmacotherapy as TDM services have become readily available in many hospitals [1,2]. As concerns about rising health care expenses have increased, the cost-effectiveness of TDM has been questioned [3]. CEA has been widely used in health care services to aid decision making in the clinical setting [4]. For CEA to be clinically meaningful, it is important to decide which costs and benefits are to be assessed [5,6]. TDM for aminoglycosides has proven to be cost-effective by decreasing nephrotoxicity and mortality [1,7,8]. TDM for conventional antiepileptic drugs including phenobarbital, phenytoin, carbamazepine, primidone, and valproic acid was found to be cost-effective or potentially cost-effective by increasing quality of life [5,6]. The cost-effectiveness of TDM for other drugs has not been thoroughly investigated [5,6]

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Conclusion