5. Pharmacoeconomic aspects and
cost-benefit evaluation of TDM center
establishment
There are controversies regarding the cost-benefit of TDM center
establishment for the patients receiving vancomycin in developing
countries. Results of many pharmacoeconomic analysis studies revealed
that by considering the total cost of TDM establishment including the
costs of work time of involved nurses, costs of sample preparation and
analysis, costs of laboratory analysis, and payment of pharmacists
involved in this drug monitoring centers, were significantly lower than
the costs of nephrotoxicity management and longer hospitalization in
cases of vancomycin-associated nephrotoxicity [17]. Results of a
pre- and post-intervention observational study revealed that TDM group
patients had shorter hospitalization period, faster clinical stability
status, and shorter courses of inpatient vancomycin administration,
compared to historical control group patients but all-cause mortality
rate was the same in these two groups of patients [71]. So,
vancomycin TDM could be significantly associated with lower costs both
for patients and health care systems. According to the reports,
pharmacist-guide vancomycin TDM could be associated with faster initial
target trough concentration achievement and improved safety and efficacy
of pharmacotherapy during hospitalization. The most important advantages
of pharmacists’ intervention include the prevention of vancomycin
associated nephrotoxicity and avoidance of further costs related to
persistent renal failure due to vancomycin over-exposure [71]. In
general, pharmacist-guided pharmacotherapy especially during the current
COVID-19 pandemic would be essential to gain optimal and individualized
pharmacotherapy based on pharmacokinetic and pharmacodynamics aspects of
administered drugs and prevention of major drug-drug interactions
[72-75].