Treatment cost of secondary peritonitis in Germany: a comparative study of medical cost incurred for tigecycline therapy and standard regimens

Introduction

Secondary peritonitis is the most frequent form of peritonitis, characterized by a high disease burden and a high mortality rate. Choice of adequate antibiotics is an independent factor for survival. The aim of this study was to compare treatment of secondary peritonitis with tigecycline (TG) with standard regimens (SR) from an economical standpoint.

Methods

After ethics committee approval, the study was performed as prospective, non-interventional cohort trial in 23 medical centers in Germany. Patients could be included if suffering from severe secondary peritonitis treated in an ICU. Patients with pregnancy, aged below 18 years and milder forms of diseases (APACHE II score <15) were not eligible. In order to compare treatment with TG with SR, the following data were documented: demographic data, disease severity scores, causing micro-organisms, laboratory parameters, and length of stay (LOS). Patients were analysed according to initial antibiotic choice except for perioperative prophylaxis. In order to balance for differences in co-morbidities and severity of disease, a matched-pairs analysis was performed based on logistic regression analysis.

Results

A total of 178 patients were enrolled (49 TG/129 SR). After logistic regression analysis and matching for gender, age ± 3 years, APACHE II score ± 1 and (non)existence of liver cirrhosis, arterial sclerosis and coronary heart disease, 15 matched pairs were built. Compared with the SR group, in the TG group was a tendency for higher creatinine, urea and glucose levels, higher number of co-morbidities (3.3 vs 3.0, NS) and higher number of pathogens isolated on initial surgery (2.2 vs 1.6, NS). There was a higher number of discharges 9/15 in the TG group (vs 7/15 SR, NS) and 6/15 patients died (vs 4/15 SR, NS). Considering these factors, there was a trend for shorter LOS in patients treated with TG (11 days vs 18 days and 8 days vs 16 days for survivors and nonsurvivors, respectively, NS) and total costs of ICU stay were significantly lower in the TG group (€8,832 vs €15,482, P = 0.023).

Conclusions

In our non-interventional study, tigecycline tended to be used in patients with more severe co-morbidities. In spite of this, there was a trend for shorter LOS and treatment costs were significantly lower, which make tigecycline an attractive treatment, also from a pharmacoeconomical standpoint.