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ORIGINAL RESEARCH article

Front. Pharmacol.
Sec. Pharmacology of Infectious Diseases
Volume 16 - 2025 | doi: 10.3389/fphar.2025.1506109

Economic impact of individualized antimicrobial dose optimization in the critically ill patient in Spain Words of main text: 2,208

Provisionally accepted
Santiago Grau Santiago Grau 1SONIA LUQUE SONIA LUQUE 1Olivia Ferrandez Olivia Ferrandez 1Adela Benitez Cano Adela Benitez Cano 1*Darío Rubio-Rodríguez Darío Rubio-Rodríguez 2*Carlos Rubio-Terrés Carlos Rubio-Terrés 2
  • 1 Hospital del Mar, Parc de Salut Mar, Barcelona, Catalonia, Spain
  • 2 Health Value, Madrid, Spain

The final, formatted version of the article will be published soon.

    Objective: To estimate the economic impact of individualized dose optimization guided by antimicrobial therapeutic drug monitoring (TDM) in Spain, compared to no monitoring.Methods: A cost analysis of antibiotic treatment of critically ill patients, with and without TDM, was performed using a probabilistic Markov model (with second-order Monte Carlo simulations). Three scenarios were analyzed based on three published meta-analyses (Analysis 1: Pai Mangalore, 2022; Analysis 2: Sanz-Codina, 2023; Analysis 3: Takahashi, 2023).Results: TDM, compared to the no-TDM option, generated according to the meta-analysis, a per patient expenditure of €195 (95%CI €194; €197) in analysis 1 or savings of -€301 (95%CI -€300; -€304) and -€685 (95%CI -€685; -€684) in analyses 2 and 3. The probability of TDM (vs no-TDM) generating savings would be 39.4%, 63.5% and 79.7% in analyses 1, 2 and 3, respectively. This discrepancy in the results is due to methodological differences, in particular in the cure rate with TDM (vs no-TDM) obtained in the meta-analyses: 12.2%, 16.6% and 16.0% more in analyses 1, 2 and 3, respectively.Conclusions: In critically ill patients undergoing antimicrobial therapy TDM, there is an increased likelihood of cure. However, the currently available data are not conclusive on the economic impact of such a therapeutic effect.

    Keywords: Therapeutic drug monitoring, antimicrobials, Critical ill patient, economic impact 1L: first-line antibiotic treatment, 2L: second-line antibiotic treatment, EFP: ex-factory price, MAX: maximum value, MIN: minimum value

    Received: 04 Oct 2024; Accepted: 28 Jan 2025.

    Copyright: © 2025 Grau, LUQUE, Ferrandez, Benitez Cano, Rubio-Rodríguez and Rubio-Terrés. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence:
    Adela Benitez Cano, Hospital del Mar, Parc de Salut Mar, Barcelona, 08003, Catalonia, Spain
    Darío Rubio-Rodríguez, Health Value, Madrid, Spain

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.