Costs and effectiveness of ciprofloxacin and ceftriaxone in treatment of typhoid fever in children in Thailand


Wannee Limpitikul and Phechnoy Singchungchai


Introduction: The burden of typhoid fever remains high in impoverished settings, and increasing antibiotic resistance is making treatment costly. The purposes of this study were: to compare the costs and the effectiveness of typhoid programs between oral and injection treatments in pediatric patients at Songkhla Hospital.

Methods: This study was an incidence-based cost-of-illness analysis from providers’ perspective. Micro-costing approach was employed for calculating patient specific data. The study was conducted in Songkhla Hospital in the southern part of Thailand from 2009 to 2010. The total number of the cases was 78. Patients taking antibiotics for 48 hours, and those suspected of having complicated typhoid fever like peritonitis, ileus, toxic encephalopathy were excluded. We collected and reviewed medical records. In all provisionally selected children, blood was drawn for complete blood count, widal test and blood culture. The statistics used in data analysis were descriptive statistics and the cost-effectiveness of typhoid treatment with the two methods was compared using independent t-test.

Results: The results of the study revealed that the average cost of typhoid treatment with oral Ciprofloxacin calculated with DRG was 3,301.88 baht which was lower than that of injection Ceftriaxone treatment calculated with DRG (3,615.05 baht). When the operation costs were considered, the results of the study remained the same, i.e. the treatment cost of typhoid with oral Ciprofloxacin was two times lower than that with injection Ceftriaxone. The average cost of the oral treatment was 2,844.45 baht, and that of the injection treatment was 5,303.19 baht. Regarding the effectiveness of typhoid treatment with Ciprofloxacin measured from the time the fever was reduced, it was found that the body temperature of the two methods of treatment were used was not significantly different (p<.05). The patients on oral medications had a fever for an average of 3.36 days while those on injection treatment had a fever for an average of 3.76 days. However, the lengths of stay (LOS) of the two groups of patients were significantly different.

Conclusions: The results of this study showed that the cost-effectiveness of oral treatment was better than injection. Bedside, the patient and caregiver spent less time when oral treatment was administered than when injection treatment was used. Therefore, the direct cost for treatment was reduced and the indirect cost as a result from LOS was also reduced. Above all, the patient did not get pain from injection while the effectiveness of fever reduction was not different.


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