ArticlePharmacoEconomics2009
Accounting for the development of antibacterial resistance in the cost effectiveness of ertapenem versus piperacillin/tazobactam in the treatment of diabetic foot infections in the UK.
Article in PharmacoEconomics, 2009. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
8 citing papers in PubMed, 2 syntheses or guidelines pooled it, 11 citations in OpenAlex.
- Economic evaluations considering costs and outcomes of diabetic foot ulcer infections: A systematic review.PloS one · 2020Pooled it
- A systematic review of cost-effectiveness analyses of complex wound interventions reveals optimal treatments for specific wound types.BMC medicine · 2015Pooled it
- Existing Evidence from Economic Evaluations of Antimicrobial Resistance-A Systematic Literature Review.Antibiotics (Basel, Switzerland) · 2025Review
- Application of dynamic modelling techniques to the problem of antibacterial use and resistance: a scoping review.Epidemiology and infection · 2018Article
- How externalities impact an evaluation of strategies to prevent antimicrobial resistance in health care organizations.Antimicrobial resistance and infection control · 2017Review
- Cost-effectiveness and pricing of antibacterial drugs.Chemical biology & drug design · 2015Article
- Antibiotic expected effectiveness and cost under real life microbiology: evaluation of ertapenem and ceftriaxone in the treatment of community-acquired pneumonia for elderly patients in Spain.ClinicoEconomics and outcomes research : CEOR · 2014Article
- A modeling framework for the evolution and spread of antibiotic resistance: literature review and model categorization.American journal of epidemiology · 2013Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
3 authors at 3 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
BACKGROUND AND
objectiveIncreased antibacterial use is associated with a greater likelihood of reduced effectiveness as a result of resistance development in the future. The objective of this study was to evaluate the cost effectiveness of ertapenem versus piperacillin/tazobactam in the treatment of diabetic foot infections (DFIs) from the UK NHS perspective, accounting for the development of antibacterial resistance over time.
methodsA decision-tree model was developed to estimate the cost effectiveness of ertapenem versus piperacillin/tazobactam at different timepoints in the 36 months following introduction of treatment. Development of antibacterial resistance was incorporated in the analysis using a previously published compartment (susceptible-infected-susceptible) model. The development of resistance was a function of the clearance rate of pathogens and the size of the proportion of the population prescribed the antibacterial. The microbiological clearance rate and clinical success rates were assumed to be related and were obtained from the SIDESTEP study. These data included resistant pathogens (either acquired or intrinsic resistance) such as Enterobacteriaceae, meticillin-resistant Staphylococcus aureus, enterococci and Pseudomonas aeruginosa. Model outcomes over time included lifetime QALYs, direct medical costs (year 2006 values) and cost per QALY saved. Clinical efficacy of second-line treatment, direct medical costs and utilities were derived from other existing studies. Probabilistic sensitivity analyses were undertaken to estimate the uncertainty of model outcomes. Costs and QALYs were discounted at 3.5% per annum.
resultsThe model suggested savings of pound407 (95% uncertainty interval [UI] -337, 1501) per patient when DFIs were treated with ertapenem instead of piperacillin/tazobactam after 1 month's treatment. Probabilistic sensitivity analysis suggested a 91% probability of the incremental cost per QALY saved being within a threshold for cost effectiveness of pound20,000. After 3 years it is expected that the antibacterial resistance profile with piperacillin/tazobactam would increase at a greater rate than with ertapenem. As a result, the cost savings with ertapenem are expected to increase to pound3465 (95% UI 2502, 4564), and ertapenem will additionally result in greater clinical success rates and lifetime QALY savings (1.16; 95% UI 0.46, 2.06).
conclusionErtapenem appears to be a cost-saving and possibly an economically dominant therapy over piperacillin/tazobactam for the treatment of patients with DFIs from the UK NHS perspective.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.