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Cost-effectiveness analysis of serum vancomycin concentration monitoring in patients with hematologic malignancies . OBJECTIVE This study evaluates the cost-effectiveness of vancomycin serum concentration monitoring in patients with hematologic malignancies . METHODS The study was designed as a prospective randomized study . Seventy immunocompromised febrile patients with hematologic malignancies were randomly assigned to either a vancomycin therapeutic drug monitoring group ( TDM group ; n = 37 ) or to a control group ( n = 33 ) . Intervention in the TDM group involved patient follow-up by a clinical pharmacist to obtain and pharmacokinetically interpret serum vancomycin concentrations for dosage individualization . RESULTS Evaluation of all patients included global clinical response and nephrotoxicity , as well as the economic costs and effectiveness derived from the vancomycin monitoring program . There were no significant differences between the TDM and control groups in the outcome measures , except for the incidence of nephrotoxicity : the rates of minor nephrotoxicity were 33.3 % and 13.5 % in the control and TDM groups , respectively . The corresponding figures for moderate nephrotoxicity were 9.1 % and 0 % . Logistic regression analysis confirmed that TDM independently reduced the incidence of nephrotoxicity in this patient population . On the basis of this reduced nephrotoxicity , a incremental cost of $ 435 per case of nephrotoxicity prevented was found for vancomycin serum concentration monitoring . CONCLUSIONS A decreased incidence of nephrotoxicity provides evidence of a real clinical benefit to patient management in patients with hematologic malignancies . The TDM for vancomycin therapy in this high-risk population has been shown to be a cost-effective procedure .
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Intervention_Physical
serum vancomycin
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Intervention_Pharmacological
vancomycin
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Intervention_Physical
vancomycin
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Intervention_Control
control group
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Intervention_Physical
vancomycin
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Intervention_Pharmacological
vancomycin
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Intervention_Physical
vancomycin
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Intervention_Physical
vancomycin
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Outcome_Physical
global clinical response
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Outcome_Physical
nephrotoxicity
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Outcome_Other
economic costs and effectiveness
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Outcome_Physical
incidence of nephrotoxicity : the rates of minor nephrotoxicity
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Outcome_Physical
moderate nephrotoxicity
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Outcome_Physical
incidence of nephrotoxicity
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Outcome_Physical
nephrotoxicity
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Outcome_Other
incremental cost
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Outcome_Physical
decreased incidence of nephrotoxicity
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Participant_Condition
hematologic malignancies
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Participant_Condition
hematologic malignancies
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Participant_Sample-size
Seventy
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Participant_Condition
immunocompromised febrile
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Participant_Condition
hematologic malignancies