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Ciprofloxacin use under a reserved drug and stepdown promotion program.

https://arctichealth.org/en/permalink/ahliterature215833
Source
Can J Hosp Pharm. 1995 Feb;48(1):35-42
Publication Type
Article
Date
Feb-1995
Author
L. Frighetto
S M Martinusen
F. Mamdani
P J Jewesson
Author Affiliation
Vancouver Hospital and Health Sciences Centre, BC.
Source
Can J Hosp Pharm. 1995 Feb;48(1):35-42
Date
Feb-1995
Language
English
Publication Type
Article
Keywords
Adult
British Columbia
Ciprofloxacin - economics - therapeutic use
Data Collection
Drug Costs
Drug Utilization Review - statistics & numerical data
Hospital Bed Capacity, 500 and over
Hospitals, Teaching
Humans
Male
Parenteral Nutrition
Pharmacy Service, Hospital - economics
Research Design
Retrospective Studies
Treatment Outcome
Abstract
This study retrospectively evaluated the use of parenteral ciprofloxacin (PC) under the influence of a reserved antimicrobial drug program and an intravenous-oral stepdown program. During the first three months following its formulary introduction, 92 PC treatment courses were initiated. Fifty of these treatment courses in 49 adults were randomly selected for study. The hematology service accounted for 50% of the courses reviewed. The balance were initiated in the intensive care unit (16%), and six other services (34%). PC was used for the treatment of febrile neutropenia (50%), respiratory tract infections (20%), gram-negative sepsis (10%), and five other indications. Initial use of the intravenous formulation was considered appropriate in 92% of courses. Stepdown therapy occurred in 17 (34%) of treatment courses. Of the 26 patients considered candidates for oral therapy, seven patients (27%) were eligible for earlier stepdown and nine patients (35%) did not receive oral drug. According to our criteria, unnecessary use of the intravenous route occurred in 20% of PC treatment days. Mean total cost (acquisition plus delivery) of therapy per course was $668. This cost was higher in the hematology service (mean $990) than any other service (p = 0.0015). When stepdown therapy was employed the mean daily cost of therapy was $43.63 vs. $55.61 when the oral dosage form was not used (p = 0.04). Parenteral drug costs totalling $6245 were avoided by subsequent use of the oral dosage form. If full compliance with stepdown criteria had occurred, an estimated total savings of $10,769 could have been realized.
PubMed ID
10141061 View in PubMed
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A cost threshold analysis of ciprofloxacin-dexamethasone versus ofloxacin for acute otitis media in pediatric patients with tympanostomy tubes.

https://arctichealth.org/en/permalink/ahliterature178618
Source
Clin Ther. 2004 Jul;26(7):1168-78
Publication Type
Article
Date
Jul-2004
Author
Peter S Roland
Allison Pontius
G. Michael Wall
Curtis R Waycaster
Author Affiliation
Department of Otolaryngology, University of Texas Southwestern Medical Center, Dallas, USA.
Source
Clin Ther. 2004 Jul;26(7):1168-78
Date
Jul-2004
Language
English
Publication Type
Article
Keywords
Anti-Bacterial Agents - economics - therapeutic use
Canada
Child
Ciprofloxacin - economics - therapeutic use
Cost-Benefit Analysis
Costs and Cost Analysis
Dexamethasone - economics - therapeutic use
Drug Therapy, Combination - economics - therapeutic use
Humans
Middle Ear Ventilation - economics
Ofloxacin - economics - therapeutic use
Otitis Media - drug therapy - economics - therapy
Physician's Practice Patterns
Questionnaires
United States
Abstract
The aim of this study was to determine the cost-effectiveness hreshold of a ciprofloxacin 0.3% and dexamethasone 0.1% (CD) otic suspension relative to olfloxacin otic solution (OFX) for the treatment of acute otitis media in pediatric patients with tympanostomy tubes (AOMT).
This study used a decision-analytic model to simulate the costs and consequences of the ototopical treatment of AOMT. The AOMT model consisted of 3 tiers of antimicrobial therapy. Each successive tier represented the repeat treatment of clinical failures from the preceding tier. Patients were modeled for treatment until cured or until third-tier therapy was complete, at which time patients were considered cured. First-tier therapy modeled a comparison of CD and OFX using efficacy rates taken from a randomized clinical trial with a population of 599 patients. Second-tier therapy modeled the use of amoxicillin and clavulanic acid using an efficacy rate taken from the medical literature. Third-tier therapy was modeled as being pathogen specific and could follow 1 of 3 possible clinical pathways: (1) PO fluconazole, (2) IM ceftriaxone, or (3) IV antibiotics administered in a hospital setting. Third-tier therapeutic pathway probabilities were based on the microbiologic spectrum of the treatment failures from the clinical trial. Cost information (in year-2003 US dollars) was taken from accepted cost reference sources and presented from the perspective of a third-party payer. The economic outcome of interest was the cost-effectiveness threshold of CD relative to OFX.
Given the model parameters, CD had a cost-effectiveness threshold value of 4.5 times the wholesale acquisition cost of OFX. Based on actual cost, first-tier CD therapy was more cost-effective than OFX up to a threshold price of US 152.64 dollars.
In this decision-analytic model, CD was more cost-effective than OFX for AOMT therapy in pediatric patients up to a threshold price of 4.5 times the price of OFX.
PubMed ID
15336482 View in PubMed
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Economic evaluation of ciprofloxacin compared with usual antibacterial care for the treatment of acute exacerbations of chronic bronchitis in patients followed for 1 year.

https://arctichealth.org/en/permalink/ahliterature199605
Source
Pharmacoeconomics. 1999 Nov;16(5 Pt 1):499-520
Publication Type
Article
Date
Nov-1999
Author
G. Torrance
V. Walker
R. Grossman
J. Mukherjee
D. Vaughan
J. La Forge
N. Lampron
Author Affiliation
Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Ontario, Canada.
Source
Pharmacoeconomics. 1999 Nov;16(5 Pt 1):499-520
Date
Nov-1999
Language
English
Publication Type
Article
Keywords
Adult
Anti-Infective Agents - economics - therapeutic use
Bronchitis - classification - drug therapy - economics
Canada
Chronic Disease
Ciprofloxacin - economics - therapeutic use
Cost-Benefit Analysis
Economics, Pharmaceutical
Female
Humans
Male
Prospective Studies
Quality-Adjusted Life Years
Severity of Illness Index
Abstract
To undertake a 1-year prospective economic evaluation of ciprofloxacin compared with usual antibacterial care (any antibacterial other than a quinolone) for the treatment of acute exacerbations of chronic bronchitis (AECB) in adults presenting with a type I or type II AECB.
Patients entered the study with an initial AECB and were randomised to the ciprofloxacin group or the usual care group. The following measurements were taken at the end of each AECB and every 3 months: resource utilisation, St. George's Respiratory Questionnaire, Nottingham Health Profile and Health Utilities Index (HUI). The following additional measurements were taken after each AECB: AECB-symptom days and willingness to pay to avoid the AECB. Economic evaluations were performed from the societal viewpoint and the viewpoint of a major third-party payer. Cost-effectiveness analysis was based on cost per AECB-symptom day averted; cost-utility analysis (CUA) was based on cost per quality-adjusted life-year (QALY) gained using the HUI as the basis for calculating QALYs. Cost-benefit analysis was based on the willingness-to-pay (WTP) data.
This was a study of outpatients enrolled from 46 family physicians and 2 respirologists in Ontario (29 sites) and Qu?bec (19 sites), Canada, between November 1993 and June 1994.
240 adult male and female patients aged > or = 18 years with chronic bronchitis.
WTP data did not pass scope tests for reasonableness. Ciprofloxacin was more costly and provided better outcomes compared with usual antibacterial care. The base-case results are as follows (1994/1995 values): the incremental annual cost was 578 Canadian dollars ($Can) from the societal viewpoint and $Can840 for the third-party payer; the cost-effectiveness ratio per AECB-symptom day averted was $Can209 from the societal viewpoint and $Can304 for the third-party payer; the cost-utility ratio per QALY gained was $Can18,600 from the societal viewpoint and $Can27,000 for the third-party payer. According to Laupacis criteria, these CUA results are strong evidence in favour of adoption from the societal viewpoint and moderate evidence in favour from the viewpoint of the third-party payer. A subgroup analysis suggests that ciprofloxacin may be particularly cost effective, even 'win-win', in patients with more severe disease.
The sensitivity analyses indicate that the results are relatively robust. Nevertheless, the statistical uncertainty in the results is sufficient that the findings cannot be accepted unequivocally. A further study with a larger sample size would be useful to confirm (or deny) the findings of this study.
PubMed ID
10662396 View in PubMed
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Effect of generics on price and consumption of ciprofloxacin in primary healthcare: the relationship to increasing resistance.

https://arctichealth.org/en/permalink/ahliterature144494
Source
J Antimicrob Chemother. 2010 Jun;65(6):1286-91
Publication Type
Article
Date
Jun-2010
Author
Ulrich S Jensen
Arno Muller
Christian T Brandt
Niels Frimodt-Møller
Anette M Hammerum
Dominique L Monnet
Author Affiliation
National Center for Antimicrobials and Infection Control, Statens Serum Institut, Copenhagen, Denmark. uje@ssi.dk
Source
J Antimicrob Chemother. 2010 Jun;65(6):1286-91
Date
Jun-2010
Language
English
Publication Type
Article
Keywords
Anti-Bacterial Agents - economics - therapeutic use
Ciprofloxacin - economics - therapeutic use
Denmark
Drug Resistance, Bacterial
Drug Utilization - statistics & numerical data
Drugs, Generic - economics - therapeutic use
Escherichia coli - drug effects - isolation & purification
Humans
Microbial Sensitivity Tests
Primary Health Care
Retrospective Studies
Urine - microbiology
Abstract
The introduction of generic versions of drugs has often resulted in an increase in the consumption of the agents involved. In December 2001, generic ciprofloxacin was marketed in Denmark. Our objective was to evaluate, in a community setting, the effect of price on consumption of ciprofloxacin and on ciprofloxacin resistance in Escherichia coli urine isolates.
We conducted a retrospective ecological study collecting monthly national data on the number of marketed versions and primary healthcare (PHC) sales of ciprofloxacin during January 1995-December 2005. Data were compared with a median price per defined daily dose (DDD) of ciprofloxacin during September 1999-December 2005. Yearly PHC consumption data from seven Danish counties were compared with the antimicrobial resistance profiles of PHC E. coli urine isolates.
During 2002, the number of marketed versions increased from 3 to 10, and the median price per DDD decreased by 53%. From 2002 to 2005, the total consumption of oral ciprofloxacin in PHC increased significantly from 0.13 DDD/1000 inhabitant-days to 0.33 DDD/1000 inhabitant-days. During the same period, the frequency of ciprofloxacin resistance increased by 200%. A statistically significant correlation was found between the consumption of ciprofloxacin and the ciprofloxacin resistance rate in E. coli urine isolates, independent of the introduction of generic ciprofloxacin.
After the introduction of generic ciprofloxacin, a significant increase in the total consumption of oral ciprofloxacin in PHC was observed in Denmark. The increase in consumption was significantly correlated with ciprofloxacin resistance in E. coli obtained from urine isolates.
Notes
Comment In: J Antimicrob Chemother. 2011 Jul;66(7):1656-821493647
PubMed ID
20363806 View in PubMed
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