Cost-Minimization of Availability of Fusidic Acid in the Treatment of Topical Infection in Iran
Abstract
Background: Since at the time of this study fusidic acid was not available in the pharmaceutical market of Iran, this study was designed to investigate the economic aspects of the availability of fusidic acid for the treatment of topical infection in Iran.Methods: A decision tree model was used to compare circumstances, in which only mupirocin and fusidic acid were available. Medical and hospitalization costs were considered as direct medical costs. Budget impact analysis and sensitivity analysis were performed to examine the robustness of the base-case analysis.Results: It was assumed that a 50/50 ratio exists between burn patients to other patients. The treatment cost of 1000 cohort hypothetical patients was estimated at $54766 when mupirocin was the only available treatment choice and $15951 when fusidic acid was available as well. In other words, overall, $39 per patient was saved when physicians could consider fusidic acid as another choice of treatment.Conclusion: The availability of fusidic acid appears to be reasonable because it reduces the costs of skin infection treatment. It also improves antibiotic consumption appropriateness.
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8. Still J, Law E, Friedman B, Fuhrman S, Newton T. Vancomycin-resistant organisms on a burn unit. South Med J. 2001; 94(8):810-2. [DOI:10.1097/00007611-200108000-00011] [PMID]
9. Ozumba U, Jiburum B. Bacteriology of burn wounds in Enugu, Nigeria. Burns. 2000; 26(2):178-80. [DOI:10.1016/S03054179(99)00075-3]
10. Lee KM, Kang HJ, Shin DH, Kim DK. Microbiologic aspects of predominant bacteria isolated from the burn patients in Korea. Burns. 2001; 27(2):136-9. [DOI:10.1016/S0305-4179(00)00086-3]
11. Taylor G, Kibsey P, Kirkland T, Burroughs E, Tredget E. Predominance of staphylococcal organisms in infections occurring in a burns intensive care unit. Burns. 1992; 18(4):332-5. [DOI:10.1016/03054179(92)90158-Q]
12. Norozi J, Heidarpour A, Mohammadi M. Acinetobacter as hospital patogenes. Iran J Infect Dis. 2001; 9(24):1-5.
13. Wong TH, Tan BH, Ling ML, Song C. Multi-resistant Acinetobacter baumannii on a burns unitclinical risk factors and prognosis. Burns. 2002; 28(4):349-57. [DOI:10.1016/S0305-4179(02)00012-8]
14. Bangert S, Levy M, Hebert AA. Bacterial resistance and impetigo treatment trends: A review. Pediatr Dermatol. 2012; 29(3):243-8. [DOI:10.1111/j.1525-1470.2011.01700.x] [PMID]
15. Eslam G, Taheri S, Naalchi F, Baseri N, Samadi R, Azarghashb E. [Study of bacteria causing skin infections and antibiotic resistance in patients referred to Shohada and Loghman hospitals (Persian)]. Pejouhesh. 2013; 36(4):205-10.
16. Patel JB, Gorwitz RJ, Jernigan JA. Mupirocin resistance. Clin Infect Dis. 2009; 49(6):935-41. [DOI:10.1086/605495] [PMID]
17. Gould I. The clinical significance of methicillin-resistant Staphylococcus aureus. J Hosp Infect. 2005; 61(4):277-82. [DOI:10.1016/j. jhin.2005.06.014] [PMID]
18. Coia JE, Duckworth GJ, Edwards DI, Farrington M, Fry C, Humphreys H, et al. Guidelines for the control and prevention of Meticillin-Resistant Staphylococcus Aureus (MRSA) in healthcare facilities. J Hosp Infect. 2006; 63(Suppl. 1):S1-S44. [DOI:10.1016/j. jhin.2006.01.001] [PMID]
19. Gastmeier P, Sohr D, Geffers C, Behnke M, Daschner F, Rüden H. Mortality risk factors with nosocomial Staphylococcus aureus infections in intensive care units: Results from the German Nosocomial Infection Surveillance System (NISS). Infection. 2005; 33(2):50-5. [DOI:10.1007/s15010-005-3186-5] [PMID]
20. Resch A, Wilke M, Fink C. The cost of resistance: Incremental cost of Methicillin-Resistant Staphylococcus Aureus (MRSA) in German hospitals. Eur J Health Econ. 2009; 10(3):287-97. [DOI:10.1007/ s10198-008-0132-3] [PMID]
21. Eliopoulos GM, Cosgrove SE, Carmeli Y. The impact of antimicrobial resistance on health and economic outcomes. Clin Infect Dis. 2003; 36(11):1433-7. [DOI:10.1086/375081] [PMID]
22. You JHS, Choi KW, Wong TY, Ip M, Ming WK, Wong RY, et al. Disease burden, characteristics, and outcomes of methicillin-resistant staphylococcus aureus bloodstream infection in Hong Kong. Asia Pac J Public Health. 2017; 29(5):451-61. [DOI:10.1177/1010539517717365] [PMID]
23. Potashman MH, Stokes M, Liu J, Lawrence R, Harris L. Examination of hospital length of stay in Canada among patients with acute bacterial skin and skin structure infection caused by methicillinresistant staphylococcus aureus. Infect Drug Resist. 2016; 9:19-33. [DOI:10.2147/IDR.S93112] [PMID] [PMCID]
24. Askarian M, Zeinalzadeh A, Japoni A, Alborzi A, Memish ZA. Prevalence of nasal carriage of methicillin-resistant Staphylococcus aureus and its antibiotic susceptibility pattern in healthcare workers at Namazi hospital, Shiraz, Iran. Int J Infect Dis. 2009; 13(5):e241-e7. [DOI:10.1016/j.ijid.2008.11.026] [PMID]
25. Mangus DJ, Fox D, Gilchrist D, Womack B, Ost J. Quantitative evaluation and laboratory studies of topical antibiotic therapy in burns. J Burn Care Res. 1985; 6(1):39-46. [DOI:10.1097/00004630198501000-00003] [PMID]
26. Saderi H, Owlia P, Habibi M. Mupirocin resistance among Iranian isolates of Staphylococcus aureus. Med Sci Monit. 2008; 14(10):BR210-3. [PMID]
27. Shahsavan S, Emaneini M, Noorazar Khoshgnab B, Khoramian B, Asadollahi P, Aligholi M, et al. A high prevalence of mupirocin and macrolide resistance determinant among Staphylococcus aureus strains isolated from burnt patients. Burns. 2012; 38(3):378-82. [DOI:10.1016/j.burns.2011.09.004] [PMID]
28. Abbasi-Montazeri E, Khosravi AD, Feizabadi MM, Goodarzi H, Khoramrooz SS, Mirzaii M, et al. The prevalence of Methicillin Resistant Staphylococcus Aureus (MRSA) isolates with high-level mupirocin resistance from patients and personnel in a burn center. Burns. 2013; 39(4):650-4. [DOI:10.1016/j.burns.2013.02.005] [PMID]
29. Schöfer H, Simonsen L. Fucidic acid in dermatology: An updated review. Eur J Dermatol. 2010; 20(1):6-15. [DOI:10.1684/ ejd.2010.0833] [PMID]
30. Hasani A, Sheikhalizadeh V, Hasani A, Naghili B, Valizadeh V, Nikoonijad AR. Methicillin resistant and susceptible Staphylococcus aureus: Appraising therapeutic approaches in the Northwest of Iran. Iran J Microbiol. 2013; 5(1):56-62. [PMID] [PMCID]
31. Den Heijer CD, Van Bijnen EM, Paget WJ, Stobberingh EE. Fucidic acid resistance in Staphylococcus aureus nasal carriage strains in nine European countries. Future Microbiol. 2014; 9(6):737-45. [DOI:10.2217/fmb.14.36] [PMID]
32. Gilbert M. Topical 2% mupirocin versus 2% fucidic acid ointment in the treatment of primary and secondary skin infections. J Am Acad Dermatol. 1989; 20(6):1083-7. [DOI:10.1016/S01909622(89)70137-7]
33. World Health Organization. Framework for action for strengthening health systems: Everybody's business [Internet]. 2007 [Updated 2007 Sep 12] Availble from: http://www.who.int/healthsystems/ topics/en/index.htm
34. Islamic Republic of Iran, Ministry of Health and Medical Education, Food and Drug Administration, Drug Price System [Internet]. 2018 [Updated 2018, Oct 05] Available from: http://irc.fda.gov.ir/nfi/Sear ch?Term=mupiro&PageNumber=1&PageSize=10&Count=0&DrugL icenses=System.Collections.Generic.List%601%5BIrfda.IRCRegistration.Models.Drug.FinishedProduct.DrugLicenseInfoVM%5D
35. Presidential Planning and Budget Organization. The quotation for diagnostic and therapeutic services in non-governmental, charitable and public institutions not belonged to the Ministry of Health and Medical Education in 2018. [Internet]. 2018 [Updated 2018 Oct 05] Available from: https://cdn.yjc.ir/files/fa/ news/1396/9/26/7241703_283.pdf
36. Central Bank of the Islamic Republic of Iran. Exchange Rate [Internet]. 2019 [Updated 2019 Dec 04]. Available from: https://www.cbi. ir/default_en.aspx
37. Sutton J, Langdon C. An analysis of the cost effectiveness of Fucidic acid cream and mupirocin ointment in the treatment of superficial skin sepsis in general practice. British J Med Econ. 1993; 6:37.
2. Koning S, van der Sande R, Verhagen AP, Lisette WA van, Smit S, Morris AD, et al. Interventions for impetigo. Cochrane Database Syst Rev. 2012; 1:CD003261. [DOI:10.1002/14651858.CD003261. pub3] [PMID]
3. Williamson DA, Carter GP, Howden BP. Current and emerging topical antibacterials and antiseptics: Agents, action, and resistance patterns. Clin Microbiol Rev. 2017; 30(3):827-60. [DOI:10.1128/ CMR.00112-16] [PMID] [PMCID]
4. Brown J, Shriner DL, Schwartz RA, Janniger CK. Impetigo: An update. Int J Dermatol. 2003; 42(4):251-5. [DOI:10.1046/j.13654362.2003.01647.x] [PMID]
5. Williamson D, Ritchie SR, Best E, Upton A, Leversha A, Smith A. A bug in the ointment: Topical antimicrobial usage and resistance in New Zealand. N Z Med J. 2015; 128(1426):103-9. [PMID]
6. D’Cunha NM, Peterson GM, Baby KE, Thomas J. Impetigo: A need for new therapies in a world of increasing antimicrobial resistance. J Clin Pharm Ther. 2018; 43(1):150-3. [DOI:10.1111/jcpt.12639] [PMID]
7. David MZ, Daum RS. Community-associated methicillin-resistant Staphylococcus aureus: Epidemiology and clinical consequences of an emerging epidemic. Clin Microbiol Rev. 2010; 23(3):616-87. [DOI:10.1128/CMR.00081-09] [PMID] [PMCID]
8. Still J, Law E, Friedman B, Fuhrman S, Newton T. Vancomycin-resistant organisms on a burn unit. South Med J. 2001; 94(8):810-2. [DOI:10.1097/00007611-200108000-00011] [PMID]
9. Ozumba U, Jiburum B. Bacteriology of burn wounds in Enugu, Nigeria. Burns. 2000; 26(2):178-80. [DOI:10.1016/S03054179(99)00075-3]
10. Lee KM, Kang HJ, Shin DH, Kim DK. Microbiologic aspects of predominant bacteria isolated from the burn patients in Korea. Burns. 2001; 27(2):136-9. [DOI:10.1016/S0305-4179(00)00086-3]
11. Taylor G, Kibsey P, Kirkland T, Burroughs E, Tredget E. Predominance of staphylococcal organisms in infections occurring in a burns intensive care unit. Burns. 1992; 18(4):332-5. [DOI:10.1016/03054179(92)90158-Q]
12. Norozi J, Heidarpour A, Mohammadi M. Acinetobacter as hospital patogenes. Iran J Infect Dis. 2001; 9(24):1-5.
13. Wong TH, Tan BH, Ling ML, Song C. Multi-resistant Acinetobacter baumannii on a burns unitclinical risk factors and prognosis. Burns. 2002; 28(4):349-57. [DOI:10.1016/S0305-4179(02)00012-8]
14. Bangert S, Levy M, Hebert AA. Bacterial resistance and impetigo treatment trends: A review. Pediatr Dermatol. 2012; 29(3):243-8. [DOI:10.1111/j.1525-1470.2011.01700.x] [PMID]
15. Eslam G, Taheri S, Naalchi F, Baseri N, Samadi R, Azarghashb E. [Study of bacteria causing skin infections and antibiotic resistance in patients referred to Shohada and Loghman hospitals (Persian)]. Pejouhesh. 2013; 36(4):205-10.
16. Patel JB, Gorwitz RJ, Jernigan JA. Mupirocin resistance. Clin Infect Dis. 2009; 49(6):935-41. [DOI:10.1086/605495] [PMID]
17. Gould I. The clinical significance of methicillin-resistant Staphylococcus aureus. J Hosp Infect. 2005; 61(4):277-82. [DOI:10.1016/j. jhin.2005.06.014] [PMID]
18. Coia JE, Duckworth GJ, Edwards DI, Farrington M, Fry C, Humphreys H, et al. Guidelines for the control and prevention of Meticillin-Resistant Staphylococcus Aureus (MRSA) in healthcare facilities. J Hosp Infect. 2006; 63(Suppl. 1):S1-S44. [DOI:10.1016/j. jhin.2006.01.001] [PMID]
19. Gastmeier P, Sohr D, Geffers C, Behnke M, Daschner F, Rüden H. Mortality risk factors with nosocomial Staphylococcus aureus infections in intensive care units: Results from the German Nosocomial Infection Surveillance System (NISS). Infection. 2005; 33(2):50-5. [DOI:10.1007/s15010-005-3186-5] [PMID]
20. Resch A, Wilke M, Fink C. The cost of resistance: Incremental cost of Methicillin-Resistant Staphylococcus Aureus (MRSA) in German hospitals. Eur J Health Econ. 2009; 10(3):287-97. [DOI:10.1007/ s10198-008-0132-3] [PMID]
21. Eliopoulos GM, Cosgrove SE, Carmeli Y. The impact of antimicrobial resistance on health and economic outcomes. Clin Infect Dis. 2003; 36(11):1433-7. [DOI:10.1086/375081] [PMID]
22. You JHS, Choi KW, Wong TY, Ip M, Ming WK, Wong RY, et al. Disease burden, characteristics, and outcomes of methicillin-resistant staphylococcus aureus bloodstream infection in Hong Kong. Asia Pac J Public Health. 2017; 29(5):451-61. [DOI:10.1177/1010539517717365] [PMID]
23. Potashman MH, Stokes M, Liu J, Lawrence R, Harris L. Examination of hospital length of stay in Canada among patients with acute bacterial skin and skin structure infection caused by methicillinresistant staphylococcus aureus. Infect Drug Resist. 2016; 9:19-33. [DOI:10.2147/IDR.S93112] [PMID] [PMCID]
24. Askarian M, Zeinalzadeh A, Japoni A, Alborzi A, Memish ZA. Prevalence of nasal carriage of methicillin-resistant Staphylococcus aureus and its antibiotic susceptibility pattern in healthcare workers at Namazi hospital, Shiraz, Iran. Int J Infect Dis. 2009; 13(5):e241-e7. [DOI:10.1016/j.ijid.2008.11.026] [PMID]
25. Mangus DJ, Fox D, Gilchrist D, Womack B, Ost J. Quantitative evaluation and laboratory studies of topical antibiotic therapy in burns. J Burn Care Res. 1985; 6(1):39-46. [DOI:10.1097/00004630198501000-00003] [PMID]
26. Saderi H, Owlia P, Habibi M. Mupirocin resistance among Iranian isolates of Staphylococcus aureus. Med Sci Monit. 2008; 14(10):BR210-3. [PMID]
27. Shahsavan S, Emaneini M, Noorazar Khoshgnab B, Khoramian B, Asadollahi P, Aligholi M, et al. A high prevalence of mupirocin and macrolide resistance determinant among Staphylococcus aureus strains isolated from burnt patients. Burns. 2012; 38(3):378-82. [DOI:10.1016/j.burns.2011.09.004] [PMID]
28. Abbasi-Montazeri E, Khosravi AD, Feizabadi MM, Goodarzi H, Khoramrooz SS, Mirzaii M, et al. The prevalence of Methicillin Resistant Staphylococcus Aureus (MRSA) isolates with high-level mupirocin resistance from patients and personnel in a burn center. Burns. 2013; 39(4):650-4. [DOI:10.1016/j.burns.2013.02.005] [PMID]
29. Schöfer H, Simonsen L. Fucidic acid in dermatology: An updated review. Eur J Dermatol. 2010; 20(1):6-15. [DOI:10.1684/ ejd.2010.0833] [PMID]
30. Hasani A, Sheikhalizadeh V, Hasani A, Naghili B, Valizadeh V, Nikoonijad AR. Methicillin resistant and susceptible Staphylococcus aureus: Appraising therapeutic approaches in the Northwest of Iran. Iran J Microbiol. 2013; 5(1):56-62. [PMID] [PMCID]
31. Den Heijer CD, Van Bijnen EM, Paget WJ, Stobberingh EE. Fucidic acid resistance in Staphylococcus aureus nasal carriage strains in nine European countries. Future Microbiol. 2014; 9(6):737-45. [DOI:10.2217/fmb.14.36] [PMID]
32. Gilbert M. Topical 2% mupirocin versus 2% fucidic acid ointment in the treatment of primary and secondary skin infections. J Am Acad Dermatol. 1989; 20(6):1083-7. [DOI:10.1016/S01909622(89)70137-7]
33. World Health Organization. Framework for action for strengthening health systems: Everybody's business [Internet]. 2007 [Updated 2007 Sep 12] Availble from: http://www.who.int/healthsystems/ topics/en/index.htm
34. Islamic Republic of Iran, Ministry of Health and Medical Education, Food and Drug Administration, Drug Price System [Internet]. 2018 [Updated 2018, Oct 05] Available from: http://irc.fda.gov.ir/nfi/Sear ch?Term=mupiro&PageNumber=1&PageSize=10&Count=0&DrugL icenses=System.Collections.Generic.List%601%5BIrfda.IRCRegistration.Models.Drug.FinishedProduct.DrugLicenseInfoVM%5D
35. Presidential Planning and Budget Organization. The quotation for diagnostic and therapeutic services in non-governmental, charitable and public institutions not belonged to the Ministry of Health and Medical Education in 2018. [Internet]. 2018 [Updated 2018 Oct 05] Available from: https://cdn.yjc.ir/files/fa/ news/1396/9/26/7241703_283.pdf
36. Central Bank of the Islamic Republic of Iran. Exchange Rate [Internet]. 2019 [Updated 2019 Dec 04]. Available from: https://www.cbi. ir/default_en.aspx
37. Sutton J, Langdon C. An analysis of the cost effectiveness of Fucidic acid cream and mupirocin ointment in the treatment of superficial skin sepsis in general practice. British J Med Econ. 1993; 6:37.
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| Issue | Vol 4 No 1/2 (2018) | |
| Section | Original Article(s) | |
| Keywords | ||
| Fusidic acid Topical infections Antimicrobial resistance Impetigo Costeffectiveness Iran | ||
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How to Cite
1.
Seyedifar M, Khorasani E, Taheri F, Soleymani F. Cost-Minimization of Availability of Fusidic Acid in the Treatment of Topical Infection in Iran. JPPM. 2018;4(1/2):10-18.
