Cost-Effectiveness of Targeted Prophylaxis among Allogenic Stem Cell Transplant Recipients
Bloodstream infections (BSI) are life-threatening complications for onco-hematologic patients. Fluoroquinolones prophylaxis (FQP) was recommended for patients with neutropenia. Later, it was correlated with increased resistance rates among this population and its role became debated. While the role...
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MDPI AG
2023-03-01
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| Series: | Pharmaceuticals |
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| Online Access: | https://www.mdpi.com/1424-8247/16/3/466 |
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| author | Nour Shbaklo Costanza Vicentini Alessandro Busca Luisa Giaccone Chiara Dellacasa Irene Dogliotti Tommaso Lupia Carla M. Zotti Silvia Corcione Francesco Giuseppe De Rosa |
| author_facet | Nour Shbaklo Costanza Vicentini Alessandro Busca Luisa Giaccone Chiara Dellacasa Irene Dogliotti Tommaso Lupia Carla M. Zotti Silvia Corcione Francesco Giuseppe De Rosa |
| author_sort | Nour Shbaklo |
| collection | DOAJ |
| description | Bloodstream infections (BSI) are life-threatening complications for onco-hematologic patients. Fluoroquinolones prophylaxis (FQP) was recommended for patients with neutropenia. Later, it was correlated with increased resistance rates among this population and its role became debated. While the role of FQ prophylaxis is still being studied, its cost-effectiveness is also unknown. The objective of this study was to evaluate the costs and effects associated with two alternative strategies (FQP vs. no prophylaxis) for patients with hematological malignancies undergoing allogenic stem cell transplant (HSCT). A decision-tree model was built integrating retrospectively collected data from a single transplant center, part of a tertiary teaching hospital in Northern Italy. Probabilities, costs and effects were considered in the assessment of the two alternative strategies. Probabilities of colonization, BSIs, extended-spectrum beta lactamase (ESBL) and <i>Klebsiella pneumoniae</i> carbapenemase (KPC) BSIs and mortality associated with infection, as well as median duration of length of stay (LOS) were calculated based on data collected between 2013 and 2021. The center applied the strategy of FQP between 2013 and 2016, and of no prophylaxis between 2016 and 2021. Data on 326 patients were collected during the considered time period. Overall, the rates of colonization, BSI, KPC/ESBL BSI, and mortality were 6.8% (95% confidence interval (CI) 2.7–13.5), 42% (9.9–81.4) and 20.72 (16.67–25.26), respectively. A mean bed-day cost of 132€ was estimated. Considering no prophylaxis vs. prophylaxis, the difference in costs ranged between additional 33.61 and 80.59€ per patient, whereas the difference in effects ranged between 0.11 and 0.03 life-years (LYs) lost (around 40 and 11 days). Given the small differences in terms of costs and effects between the two strategies, no prophylaxis seems an appropriate choice. Furthermore, this analysis did not consider the broader effect on hospital ecology of multiple doses of FQP, which could provide further support for the strategy of no prophylaxis. Our results suggest that the necessity for FQP in onco-hematologic setting should be determined based on local antibiotic resistance patterns. |
| first_indexed | 2024-03-11T06:02:08Z |
| format | Article |
| id | doaj.art-595c709e1b4348b9ab55f4ed337c75ad |
| institution | Directory Open Access Journal |
| issn | 1424-8247 |
| language | English |
| last_indexed | 2024-03-11T06:02:08Z |
| publishDate | 2023-03-01 |
| publisher | MDPI AG |
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| series | Pharmaceuticals |
| spelling | doaj.art-595c709e1b4348b9ab55f4ed337c75ad2023-11-17T13:13:13ZengMDPI AGPharmaceuticals1424-82472023-03-0116346610.3390/ph16030466Cost-Effectiveness of Targeted Prophylaxis among Allogenic Stem Cell Transplant RecipientsNour Shbaklo0Costanza Vicentini1Alessandro Busca2Luisa Giaccone3Chiara Dellacasa4Irene Dogliotti5Tommaso Lupia6Carla M. Zotti7Silvia Corcione8Francesco Giuseppe De Rosa9Department of Medical Sciences, Infectious Diseases, University of Turin, 10124 Turin, ItalyDepartment of Public Health and Paediatrics, University of Turin, 10124 Turin, ItalyStem Cell Transplant Center, AOU Citta’ Della Salute E Della Scienza, 10126 Turin, ItalyStem Cell Transplant Center, AOU Citta’ Della Salute E Della Scienza, 10126 Turin, ItalyStem Cell Transplant Center, AOU Citta’ Della Salute E Della Scienza, 10126 Turin, ItalyStem Cell Transplant Center, AOU Citta’ Della Salute E Della Scienza, 10126 Turin, ItalyUnit of Infectious Diseases, Cardinal Massaia, 14100 Asti, ItalyDepartment of Public Health and Paediatrics, University of Turin, 10124 Turin, ItalyDepartment of Medical Sciences, Infectious Diseases, University of Turin, 10124 Turin, ItalyDepartment of Medical Sciences, Infectious Diseases, University of Turin, 10124 Turin, ItalyBloodstream infections (BSI) are life-threatening complications for onco-hematologic patients. Fluoroquinolones prophylaxis (FQP) was recommended for patients with neutropenia. Later, it was correlated with increased resistance rates among this population and its role became debated. While the role of FQ prophylaxis is still being studied, its cost-effectiveness is also unknown. The objective of this study was to evaluate the costs and effects associated with two alternative strategies (FQP vs. no prophylaxis) for patients with hematological malignancies undergoing allogenic stem cell transplant (HSCT). A decision-tree model was built integrating retrospectively collected data from a single transplant center, part of a tertiary teaching hospital in Northern Italy. Probabilities, costs and effects were considered in the assessment of the two alternative strategies. Probabilities of colonization, BSIs, extended-spectrum beta lactamase (ESBL) and <i>Klebsiella pneumoniae</i> carbapenemase (KPC) BSIs and mortality associated with infection, as well as median duration of length of stay (LOS) were calculated based on data collected between 2013 and 2021. The center applied the strategy of FQP between 2013 and 2016, and of no prophylaxis between 2016 and 2021. Data on 326 patients were collected during the considered time period. Overall, the rates of colonization, BSI, KPC/ESBL BSI, and mortality were 6.8% (95% confidence interval (CI) 2.7–13.5), 42% (9.9–81.4) and 20.72 (16.67–25.26), respectively. A mean bed-day cost of 132€ was estimated. Considering no prophylaxis vs. prophylaxis, the difference in costs ranged between additional 33.61 and 80.59€ per patient, whereas the difference in effects ranged between 0.11 and 0.03 life-years (LYs) lost (around 40 and 11 days). Given the small differences in terms of costs and effects between the two strategies, no prophylaxis seems an appropriate choice. Furthermore, this analysis did not consider the broader effect on hospital ecology of multiple doses of FQP, which could provide further support for the strategy of no prophylaxis. Our results suggest that the necessity for FQP in onco-hematologic setting should be determined based on local antibiotic resistance patterns.https://www.mdpi.com/1424-8247/16/3/466antibiotic prophylaxisbloodstream infectionsonco-hematologic transplantmulti-drug resistant infectionscost-effectiveness analysis |
| spellingShingle | Nour Shbaklo Costanza Vicentini Alessandro Busca Luisa Giaccone Chiara Dellacasa Irene Dogliotti Tommaso Lupia Carla M. Zotti Silvia Corcione Francesco Giuseppe De Rosa Cost-Effectiveness of Targeted Prophylaxis among Allogenic Stem Cell Transplant Recipients Pharmaceuticals antibiotic prophylaxis bloodstream infections onco-hematologic transplant multi-drug resistant infections cost-effectiveness analysis |
| title | Cost-Effectiveness of Targeted Prophylaxis among Allogenic Stem Cell Transplant Recipients |
| title_full | Cost-Effectiveness of Targeted Prophylaxis among Allogenic Stem Cell Transplant Recipients |
| title_fullStr | Cost-Effectiveness of Targeted Prophylaxis among Allogenic Stem Cell Transplant Recipients |
| title_full_unstemmed | Cost-Effectiveness of Targeted Prophylaxis among Allogenic Stem Cell Transplant Recipients |
| title_short | Cost-Effectiveness of Targeted Prophylaxis among Allogenic Stem Cell Transplant Recipients |
| title_sort | cost effectiveness of targeted prophylaxis among allogenic stem cell transplant recipients |
| topic | antibiotic prophylaxis bloodstream infections onco-hematologic transplant multi-drug resistant infections cost-effectiveness analysis |
| url | https://www.mdpi.com/1424-8247/16/3/466 |
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