International Journal of Clinical Pharmacy

, Volume 35, Issue 6, pp 1245–1250 | Cite as

Drug utilization pattern and cost for the treatment of severe sepsis and septic shock in critically ill cancer patients

  • Lama NazerEmail author
  • Mohammad Al-Shaer
  • Feras Hawari
Research Article


Background Cancer patients are at high risk for developing sepsis. To our knowledge, there are no studies that evaluated the type of medications utilized and the associated cost in cancer patients with severe sepsis and septic shock. Objective To describe the drug utilization pattern and drug cost in the treatment of cancer patients with severe sepsis and septic shock. Setting 12-bed medical/surgical intensive care unit (ICU) of a comprehensive teaching cancer center. Methods A retrospective cohort study of cancer patients with severe sepsis or septic shock who were treated in the ICU between January and December, 2010. The ICU sepsis database was used to identify patients. The patient demographics and characteristics were recorded. In addition, the number and type of prescribed medications, total cost for each medication, type of infection, and culture results were determined. Main outcome measure The main outcomes were the type of medication classes utilized and the cost of the medications. Results During the study period, 116 cases were identified. Upon presentation, the mean Acute Physiology and Chronic Health Evaluation II (APACHE II) score was 21.8 (SD ±7.8), 30 (25.9 %) patients had neutropenia, and 94 (81 %) had positive cultures. The total cost of the medications prescribed for this cohort of patients was 291,030 Euro. The mean number of medications prescribed per patient and the mean total cost per patient were 11.7 (SD ±4.7) and 2,509 Euro (SD ±2,844), respectively. The most commonly prescribed medication classes were acid suppressive therapy, glycopeptides, penicillins/cephalosporins and vasopressors prescribed in 113 (97 %), 104 (89.7 %), 103 (88.9 %), and 102 (88 %) patients, respectively. The highest medication costs were associated with antifungals (mean 1,288 Euro/patient) and colony stimulating factors (mean 829 Euro/patient), prescribed in 55 (47.4 %) and 37 (31.9 %) patients, respectively. Medication costs were higher in non-survivors, compared to survivors (3,664 Euro vs. 1,430 Euro, p = 0.0001), and in patients with positive cultures, compared to patients with negative cultures (3,198 Euro vs. 1,865 Euro, p = 0.0004). Conclusion In cancer patients with severe sepsis and septic shock, multiple medications are prescribed which are associated with high cost.


Cancer Cost Drug utilization Jordan Sepsis Septic shock 






Conflict of interest



  1. 1.
    Danai PA, Moss M, Mannino DM, Martin GS. The epidemiology of sepsis in patients with malignancy. Chest. 2006;129:1432–40.PubMedCrossRefGoogle Scholar
  2. 2.
    Martin GS, Mannino DM, Eaton S, Moss M. The epidemiology of sepsis in the United States from 1979 through 2000. N Engl J Med. 2003;348:1546–54.PubMedCrossRefGoogle Scholar
  3. 3.
    Alberti C, Brun-Buisson C, Burchardi H, Martin C, Goodman S, Artigas A, et al. Epidemiology of sepsis and infection in ICU patients from an international multicentre cohort study. Intensive Care Med. 2002;28(2):108–21.PubMedCrossRefGoogle Scholar
  4. 4.
    Williams MD, Braun LA, Cooper LM, Johnston J, Weiss RV, Qualy RL, et al. Hospitalized cancer patients with severe sepsis: analysis of incidence, mortality, and associated costs of care. Crit Care. 2004;8(5):R291–8 Epub 2004 Jul 5.PubMedCrossRefGoogle Scholar
  5. 5.
    Sogayar AM, Machado FR, Rea-Neto A, Dornas A, Grion CM, Lobo SM, et al. A multicenter, prospective study to evaluate costs of septic patients in Brazilian intensive care units. Pharmacoecomics. 2008;26:425–34.CrossRefGoogle Scholar
  6. 6.
    Moerer O, Schmid A, Hofmann M, Herklotz A, Reinhart K, Werdan K, et al. Direct costs of severe sepsis in three German intensive care units based on retrospective electronic patient record analysis of resource use. Intensive Care Med. 2002;28:1440–6.PubMedCrossRefGoogle Scholar
  7. 7.
    Weber RJ, Kane SL, Oriolo VA, Saul M, Skledar SJ, Dasta JF. Impact of intensive care unit (ICU) drug use of hospital costs: a descriptive analysis with recommendations for optimizing ICU pharmacotherapy. Crit Care Med. 2003;31(1):S17–24.PubMedCrossRefGoogle Scholar
  8. 8.
    Hawari FI, Al Najjar TI, Zaru L, Al Fayoumee W, Salah SH, Mukhaimar MZ. The effect of implementing high-intensity intensive care unit staffing model on outcome of critically ill oncology patients. Critical Care Med. 2009;37:1967–71.CrossRefGoogle Scholar
  9. 9.
    Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, et al. Suriviving sepsis campaign: international guidelines for management of severe sepsis and septic shock, 2012. Intensive Care Med. 2013;39:165–228.PubMedCrossRefGoogle Scholar
  10. 10.
    Dellinger RP, Levy MM, Carlet JM, Bion J, Parker MM, Jaeschke R, et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2008. Crit Care Med. 2008;36:296–327.PubMedCrossRefGoogle Scholar
  11. 11.
    Freifeld AG, Bow EJ, Sepkowitz KA, Boeckh MJ, Ito JI, Mullen CA, et al. Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the Infectious Diseases Society of America. Clin Infect Dis. 2011;51:427–31.CrossRefGoogle Scholar
  12. 12.
    Kuderer NM, Dale DC, Crawford J, Cosler LE, Lyman GH. Mortality, morbidity, and cost associated with febrile neutropenia and adult cancer patients. Cancer. 2006 May 15;106(10):2258.Google Scholar

Copyright information

© Koninklijke Nederlandse Maatschappij ter bevordering der Pharmacie 2013

Authors and Affiliations

  1. 1.Department of PharmacyKing Hussein Cancer CenterAmmanJordan
  2. 2.Section of Pulmonary and Critical Care, Department of MedicineKing Hussein Cancer CenterAmmanJordan

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