Abstract
There are a number of effective but highly toxic drugs that exhibit a narrow therapeutic index and marked intersubject pharmacokinetic variability. Optimal therapy with such drugs requires therapeutic drug monitoring (TDM) in order to safely obtain the desired clinical effects. A systematic review was carried out to document the cost-effectiveness of TDM. The Cochrane database and Medline were searched. Reference lists of articles found were searched manually for relevant articles. Very few studies are performed that document the cost-effectiveness of TDM. Only for aminoglycosides it has been demonstrated that TDM is cost-effective. For the other classes of TDM drugs, its rationale has been made plausible, but cost-effectiveness has not been investigated. Since the use of many of these drugs would contain risks of underdosing or overdosing without TDM, emphasis should not be placed on its cost-effectiveness, but rather on how to use it in the most cost-effective and clinically effective manner possible.
| Translated title of the contribution | Better treatment for less money. Rationale and cost-effectiveness of therapeutic drug monitoring(1) |
|---|---|
| Original language | Dutch |
| Pages (from-to) | 1061-1066 |
| Number of pages | 6 |
| Journal | Pharmaceutisch Weekblad |
| Volume | 138 |
| Issue number | 30 |
| Publication status | Published - 25-Jul-2003 |
Keywords
- aminoglycoside antibiotic agent
- antibiotic agent
- anticonvulsive agent
- carbamazepine
- felbamate
- gabapentin
- lamotrigine
- oxcarbazepine
- phenobarbital
- phenytoin
- primidone
- tiagabine
- topiramate
- valproic acid
- vancomycin
- vigabatrin
- zonisamide
- article
- cost effectiveness analysis
- drug blood level
- drug efficacy
- drug monitoring
- drug overdose
- drug safety
- health care cost
- health care quality
- human
- nephrotoxicity
- ototoxicity
- risk assessment
- side effect