Therapeutic drug monitoring versus Bayesian AUC-based dosing for vancomycin in routine practice: a cost–benefit analysis.

This article focuses on a cost–benefit analysis comparing Bayesian area under the curve (AUC)-based dosing, using validated software (InsightRX Nova™), with conventional therapeutic drug monitoring (TDM) of continuously infused vancomycin in hospitalized non-critically ill adults with severe Gram-positive infections. The study used a decision tree model from a hospital perspective to simulate treatment costs, vancomycin-associated acute kidney injury (AKI) risk, and related costs over 14 days. Results showed that AUC-based dosing reduced overall treatment costs by €77.4 per patient compared to TDM, yielding a return on investment (ROI) of €1.9 for every €1 spent on software, with break-even reached after treating 313 patients annually. Sensitivity analyses identified the reduction in AKI risk as the most influential factor for cost savings, and the findings suggest that Bayesian AUC-based dosing is a cost-saving and feasible strategy in this clinical context.