Cost effectiveness of three drugs for the treatment of S. aureus infections in Nigeria
- 164 Downloads
Background Resistance of microorganisms to existing antimicrobial agents threatens the effective utilization of available resources in sub-Saharan Africa. Cost-effective utilization of antibacterial agents is essential in effective health care delivery in Nigeria. Objectives To determine the most cost effective antibacterial agent in the treatment of S. aureus infections in Lagos metropolis. Setting The study was carried out in a teaching hospital, a specialist hospital, a referral center and two private hospitals. Methods Cost effectiveness analysis of ciprofloxacin, cefuroxime and gentamicin identified to be most effective agent against 463 clinical isolates of S. aureus obtained from the five hospitals was carried out on the basis of societal, health care and third party perspectives using ‘decision table” as an analytical model. Criteria considered in the model included degree of efficacy of the agents, adherence tendencies and tolerability. Both direct (cost of drugs, diagnosis/monitoring, personnel and transportation) and indirect (loss of productivity) costs were evaluated. Main outcome measures These include economic outcome as total therapy cost, clinical outcomes as extent of antibacterial effectiveness obtained from degree of antibacterial efficacy, a proxy measurement of cure rates, and adherence tendency. Humanistic outcome was also measured as tolerability prorated from literature reported degree of adverse drug reactions events, risk of infection and pains from drug administration. Results Ciprofloxacin tablet is a dominant option and much more cost-effective than either cefuroxime or gentamicin in the treatment of S. aureus in Lagos. Regardless of the perspective of analysis, ciprofloxacin has the least cost effectiveness ratio of NGN4214.66 ($28.09), NGN2392.63 ($16.00) and NGN2048.66 ($13.65) from societal, health care and third party payer perspectives, respectively. Sensitivity analysis by increasing the effectiveness index of gentamicin injection-the least cost effective option to the value for the most cost effective option did not change the results. Conclusion Ciprofloxacin should be used as first-line-treatment of S aureus in Lagos as it will lead to significant cost savings in the treatment of S. aureus infections.
KeywordsAntibacterial therapy Cost effectiveness analysis Cost of therapy Nigeria Pharmacoeconomics Staphylococcus aureus
The cooperation and support of the management and staff of all the hospitals is highly appreciated. The authors express gratitude for the input of Dr. Patrick O. Erah of University of Benin, Nigeria in manuscript revision.
No special funding was obtained for this study.
Conflicts of interest
- 3.World Health Organisation. Global strategy for containment of anti-microbial resistance. Geneva, Switzerland: World Health Organisation, 2001; WHO/CDS/CSR/DRS/2001.2. Google Scholar
- 4.Adesida S, Bockens, H, Babajide, B, Kehinde, A, Snijders, S, van Leeuwen W. et al. A major epidemic clones of Staphylococcus aureus in Nigeria. Microb Drug Resist. 2005 Summer;11(2):115–121.Google Scholar
- 5.Suleiman IA, Tayo F. Comparative costs of antibacterial usage in sexully transmitted infections in a Nigerian teaching hospital. Trop J Pharm Res. 2010;9(6):549–55.Google Scholar
- 6.Suleiman IA, Tayo F. Cost of therapy evaluation in the treatment of sexually transmitted infections in a Nigerian teaching hospital. J Pharm Health Serv Res. 2012; 3:115–120. http://onlinelibrary.wiley.com/doi/10.1111/j.1759-8893.2011.00067.x.
- 8.Drummond MF. Method for the Economic evaluation of health care programmes. 3rd ed. Oxford: Oxford University Press; Preview 2005. ISBN: 0-19-852945-7.Google Scholar
- 9.Centre for Disease Control (CDC). Cost effectiveness analysis. Centre for Disease Control and Prevention, Atlanta, Georgia, USA. www.cdc.gov/owcd/eet/CostEffect2/Fixed/1.html. Accessed on 28th March 2012.
- 10.Murray PR, Baron FJ, Pfaller MA, Tenover FC, Yolken RH. Manual of clinical microbiology. 7th ed. Washington: ASM Press; 1999. ISBN: 1555812554, 9781555812553.Google Scholar
- 11.National Committee for Clinical Laboratory Standard Institute (NCCLS). Performance standards for antimicrobial disk susceptibility tests. Approved standard M2-A7 NCCLS, Wayne, PA. The Committee 2001.Google Scholar
- 12.Clinical and Laboratory Standard Institute (CLSI). Performance standards for antimicrobial disk susceptibility tests. Approved standard M2-A10, Wayne, PA: Clinical and Laboratory Standards Institute; 2009. ISBN: 1562385887, 9781562385880.Google Scholar
- 13.Cano SB, Fujita NK. Formulary evaluation of third generation cephalosporins using decision analysis. Am J of Hosp Pharm. 1988;45:566–9.Google Scholar
- 14.Suleiman IA, Tayo F. Pharmacoeconomic evaluation of antimicrobial agents in the treatment of sexually transmitted diseases in Lagos University Teaching Hospital. West Afr J Pharm. 2004;18(1):42–52.Google Scholar
- 15.Neithimer AI. The defined daily dose system (DDD) for drug utilization review. Hosp Pharm. 1986;21:233–41.Google Scholar
- 16.WHO Collaborating Centre for Drug Statistics Methodology. Guidelines for ATC classification and DDD assignment 2012. Oslo; 2011. ISSN: 1726-4898, ISBN: 978-82-8082-477-6.Google Scholar
- 17.Joel E, Sagel BA. Cost of illness studies—a primer. North Carolina: RTI International RTI-UNC Centre for Excellence in Health promotion Economics; 2006.Google Scholar
- 19.Taylor O, Chukwani CM, Eniojukan JF, Fajemirokun O. Socioeconomic evaluation of parenteral antibacterial therapy in Lagos University Teaching Hospital. Results of a retrospective survey. West Afr J Pharm. 1997;11(2):78–86.Google Scholar
- 20.Mandell LA. Improved safety profile of newer fluoroquinolone. In: Ronald AR, Low DE, editors. Fluoroquinolone Antibiotics. Basel: Birkhauser; 2003. pp. 73–86. ISBN: 3-7643-6591-9.Google Scholar
- 21.American Hospital Formulary Services Drug information® AHFS. 1999 edition. Bethesda, MD, USA: American Society of Health-System Pharmacists. American Society of Health-System Pharmacists Inc.1999; pp. 123–226. ISBN: 978-1-58528-247-0.Google Scholar
- 24.Ghebremedhin B, Olugbosi MO, Raji AM, Layer F, Bakare RA, König B, König W. Emergence of a community-associated methicillin-resistant Staphylococcus aureus strain with a unique resistance profile in Southwest Nigeria. J Clin Microbiol. 2009;47(9):2975–80. (Epub 2009 Jul 1).PubMedCrossRefGoogle Scholar
- 25.Terry Alli OA, Ogbolu DO, Akorede E, Onemu OM, Okanlawon BM. Distribution of mecA gene amongst Staphylococcus aureus isolates from South western Nigeria. Afr J Biomed Res. 2011;14(1):9–16.Google Scholar
- 27.Bounthavong M, Zargarzadeh A, Hsu DI, Vanness DJ. Cost-effectiveness analysis of linezolid, daptomycin, and vancomycin in methicillin-resistant Staphylococcus aureus: complicated skin and skin structure infection using Bayesian methods for evidence synthesis. Value Health. 2011;14(5):631–9.PubMedCrossRefGoogle Scholar