2012년 Vol.29 No.02
Vancomycin is the drug of choice for the treatment of systemic infections, such as
methicillin resistant Staphylococcus aureus (MRSA), septic shock, and pharmacokinetic monitoring and dosage adjustment of vancomycin to optimize treatment treatment, and which minimizes the adverse effects, such as nephrotoxicity, are performed by pharmacists as major clinical service.
This study was conducted to evaluate the economic effect, and validity of this service through cost-effectiveness analysis of clinical pharmacokinetic consultation service for vancomycin. An analysis was performed for subpopulations of patients receiving concomitant nephrotoxic agents, and those receiving long term (more than 14 days) therapy. To determine the cost-effectiveness of pharmacokinetic dosage adjustment of vancomycin to prevent nephrotoxicity, a decision tree was used, as a part of modeling by referring to the precedent studies about economic effect of clinical pharmacokinetic consultation service. The frequency of vancomycin serum through concentrations
of less than or equal to 20 mg/L and greater than 20 mg/L were determined by a retrospective review of 45 patients (therapeutic monitoring group; n=14, non therapeutic monitoring group; n=31), and results of published clinical studies were used to determine the probability of nephrotoxicity associated with vancomycin trough concentration.
The mean cost of treating nephrotoxicity was ＼ 986,536. The mean cost for preventing nephrotoxic episode was ＼ 184,602 (sensitivity analysis ＼ -318,986~3,295,358), in all patients. The subgroup analysis revealed a cost of ＼ -343,618 (sensitivity analysis ＼ -620,074~1,364,032) for the prevention of nephrotoxic episode in those receiving concomitant nephrotoxic agents, ＼ -705,639 (sensitivity analysis ＼ -826,425~40,470) in those receiving long term therapy.
The evaluation by a decision tree analysis, over a range of assumptions, ICER suggests that pharmacokinetic monitoring and dosage adjustment to prevent nephrotoxicity are cost-effective for all patients, especially, in those receiving concomitant nephrotoxic agents and receiving long term therapy for more than 14 days.