Research Article Open Access

Evaluating the use of Ertapenem (Invanz®) in a Hospital System-Epidemiologic and Financial Implications

Abstract

Purpose: Carbapenems may represent the last effective antibiotics for many multi-drug-resistant gram-negative infections, warranting judicious use in order to curb resistance. In an effort to examine use of a last-line antimicrobial agent and minimize antimicrobial expenditures, ertapenem utilization and wholesale acquisition cost (WAC) expenditures were described at three facilities in San Antonio, Texas. Methods: This multicenter, retrospective study included 1,448 patients who received ertapenem between July 1, 2013 and December 31, 2013. Patients were analyzed based on number of doses, treatment indication, prescribing physician’s specialty, and available microbiology lab results. WAC information was obtained from Amerisource Bergen and RED BOOK for projection of cost savings with an alternative therapeutic option (cefazolin+metronidazole) from the organizational perspective. Results: In total, 3,301 doses of ertapenem were administered, representing an average monthly use of 51.1 doses per 1,000 patient days and a WAC of $270,259 ($81.87/day). Internal medicine practitioners were responsible for the highest utilization, with 1,138 doses (34%) administered during the study period. General surgery, colorectal surgery, emergency medicine, and family medicine followed, with 480 (15%), 413 (13%), 414 (13%), and 290 (9%) ertapenem doses administered, respectively. By comparison, use of cefazolin+metronidazole in the study population resulted in an estimated WAC of $29,808 ($9.03/day). This represented a potential cost savings of $240,451. Conclusion: Analysis of ertapenem utilization at three regional hospitals over a 6-month period revealed substantial usage, which may negatively influence local resistance patterns. Additionally, use of cefazolin+metronidazole offers a noteworthy cost-savings potential.

Andrew Delgado*, Maren C. Cowley, Gerard W. Gawrys, Bryson M. Duhon, Jim M. Koeller

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