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Meta-analysis supports the cost-effectiveness of Bayesian dosing software—but reinforces perceived barriers to adoption

In this article:

Charles Cornish, CPA, MBA

A recent study evaluated the incidence of acute kidney injury (AKI) in area under the curve (AUC) dosing versus trough-only guided dosing for vancomycin. The study conducted a meta-analysis of 10 peer-reviewed studies featuring a comparison of the two dosing methods and their association with AKI.  

The study concluded that:

  • AUC-guided dosing significantly reduced AKI as compared to trough-guided dosing
  • The use of Bayesian dosing software can help hospitals achieve the greatest cost-saving benefit compared to alternative methods of calculating AUC
  • Following the 2020 vancomycin dosing guidelines can both reduce AKI and increase the antibiotic’s efficacy
  • The overall savings outweigh the costs associated with the transition from trough to AUC-guided dosing

I have teased out some key points raised in the Discussion segment of the study which deserve further color:

«Our results support the updated guidelines for vancomycin, which aim to minimize vancomycin-induced AKI and maintain efficacy against invasive MRSA infections through AUC-guided dosing. However, widespread implementation of these guidelines has been slow and widely debated due to various concerns ranging from logistic to financial.»

Response: Despite the COVID-19 pandemic, DoseMeRx has seen a sharp 300% increase in hospitals adopting our Bayesian dosing solution and following the recommended vancomycin guidelines.

The study further explains why broader adoption may be slow:

«Many institutions plan to incorporate AUC-based dosing for all adult patients, which may be due to pragmatic reasons to limit confusion or additional training requirements.»

Response: DoseMeRx is heavily invested in addressing the tangible and intangible concerns that hospitals face when taking the transition from trough to AUC-guided dosing. We offer several resources to provide accurate and up-to-date information regarding dosing, including peer-reviewed protocols, to training workshops and CE-accredited courses. Customers also have access to our Clinical Advisory Board, which is stacked with experts who readily share their knowledge. Finally, state-of-the-art implementation software enables transparent, swift, and controllable change management.

«Cost is often a barrier to switching vancomycin dosing methods… The cost of Bayesian software ranges from $10,000 to $50,000 per year…»

Response: We are aware some providers continue to price solutions at this level. However, as the most cost-effective solution on the market, your cost-benefit analysis will be far more enticing with DoseMeRx. Our solutions start as low as $1,990 per year and can accrue to approximately $10,000 for larger sites that select all the bells and whistles (e.g. integrations, additional therapeutic areas, embedded analytics).

«Since the results remain significant in the subgroup using the strictest definition for AKI, AUC-guided dosing would likely remain beneficial in clinical settings where more lenient criteria may be used to define AKI

Response: Institutions vary in how they monitor the AKI rate due to the several definitions of nephrotoxicity. DoseMeRx’s embedded analytics solution helps monitor the percentage of patients as risk based on your institutional preference (e.g., AKIN, KDIGO).

Ultimately, we agree with the study’s findings:

«Importantly, the study provided estimates of AKI based on trough, two-concentration AUC, and Bayesian dosing using available literature. These data support the use of Bayesian software to generate the greatest cost savings benefit.«

Response: We agree with the study’s data supporting Bayesian software to have the greatest cost savings benefits, as DoseMeRx has demonstrated its ability to help customers achieve both their financial and clinical goals.

In short, the study claims cost to be one of the primary causes of slow adoption of AUC-guided dosing; however, it does not take into account DoseMeRx’s affordable and competitive pricing structure for institutions of all sizes. Logistical concerns are easily addressed with DoseMeRx’s best-in-class customer support service­s, ranging from seamless implementation to live training sessions.

Our dedicated team is available 24/7 to help you avoid any of the (perceived) barriers to implementing Bayesian dosing software. Contact us today for an estimate of your institution’s personalized cost savings.

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