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].