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International Journal of Clinical Pharmacy

, Volume 40, Issue 5, pp 1051–1058 | Cite as

Cost-effectiveness analysis of low versus high dose colistin in the treatment of multi-drug resistant pneumonia in Saudi Arabia

  • Abdul Karim Suleman CaraEmail author
  • Syed Tabish Razi Zaidi
  • Fatima Suleman
Research Article

Abstract

Background Gram negative pathogens are increasingly resistant to commonly used first line antibiotics and colistin is in most cases the only medicine available. There is very limited information available comparing the effectiveness and costs of low versus high dose colistin with studies showing efficacy with both doses and with variable levels of adverse effects. The absence of a definite dosing strategy makes a model to compare low dose and high dose colistin invaluable in making decisions regarding the appropriate use of colistin. Objective This study was designed to evaluate the cost effectiveness of low versus high dose colistin in the treatment of Pneumonia caused by colistin-only sensitive gram negative bacteria from the perspective of a tertiary care hospital in Saudi Arabia. Setting 300-bed tertiary care hospital in Saudi Arabia. Method A retrospective review was conducted to compare the costs and outcomes of treatment of pneumonia with low versus high dose colistin. The model followed an average patient from initiation of treatment until clinical cure or failure. Main outcome measures The main outcomes were cure, nephrotoxicity, total direct costs per episode, cost per additional cure and cost per nephrotoxicity avoided. Results There was no significant difference between high and low dose colistin with regards to clinical cure (30% vs. 21%; p = 0.292). Significantly more patients experienced nephrotoxicity with high versus low dose colistin (30% vs. 8%; p = 0.004). With low dose colistin the incremental costs per nephrotoxicity avoided was SAR—3056.28. One-way sensitivity analyses did not change the overall results. Conclusion Low dose was not inferior to high dose colistin in terms of clinical cure and had a lower incidence of nephrotoxicity resulting in significant cost avoidance.

Keywords

Colistin Cost effectiveness Efficacy Gram negative Multi drug resistant Pneumonia Saudi Arabia 

Notes

Acknowledgements

We thank Ms. Analyn Crisostomo (B.Pharm) for collecting data on some study variables and Ms. Iman Moustafa (M.Pharm) for assistance with layout and proof reading.

Funding

None.

Conflicts of interest

The authors declare that they have no conflicts of interest.

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Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  • Abdul Karim Suleman Cara
    • 1
    Email author
  • Syed Tabish Razi Zaidi
    • 2
  • Fatima Suleman
    • 3
  1. 1.King Abdulaziz HospitalMinistry of National Guard-Health AffairsAl-HasaSaudi Arabia
  2. 2.School of HealthcareUniversity of LeedsLeedsUnited Kingdom
  3. 3.School of Health SciencesUniversity of KwaZulu-NatalDurbanSouth Africa

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