Teicoplanin or vancomycin in febrile neutropenic children with cancer: A randomized study on cost effectiveness

This study had for aim to compare two antibiotic regimens, one containing teicoplanin and the other vancomycin, in terms of sleep and cost, for children with cancer experiencing febrile neutropenia after conventional chemotherapy. Both glycopeptides are equally effective antibacterial agents. Teicoplanin is more expensive than vancomycin but is administered once a day whereas vancomycin is administered four times a day. A randomized trial was carried out in a pediatric oncology department. Febrile neutropenic children received ceftazidime (90 mg/kg/day) combined with teicoplanin 10 mg/kg once daily or with vancomycin 10 mg/kg every 6 hours. A nurse recorded whether the child was asleep or not at night time, every hour for 12 hours. The cost of the therapy was that of all administered drugs (purchase and delivery costs, added to nursing time spent on preparation and the administration) and of laboratory work (cost of biological sampling, laboratory testing, and radiological study), 67 children were randomized from January 1995 to May 1996, 65 children were assessable (32 in the teicoplanin group and 33 in the vancomycin group), The number of night time sleeping hours did not differ between the two groups: 7.0 hours in the teicoplanin group and 7.2 hours in the vancomycin group. The cost for antibiotic regimen was higher in the teicoplanin group than in the vancomycin group (p = 0.006), The difference of median costs between the two groups was 1,600 FF for an average 6 day treatment, This variation was due to the difference between the costs of teicoplanin and vancomycin; the costs of other antibiotics were comparable. Total costs (for drugs, laboratory tests, and radiological studies) were not significantly different between the two groups. The two antibiotic regimens were assessed to be comparable in terms of sleep but the cost analysis showed that the vancomycin regimen was preferable to its teicoplanin counterpart.