Review ArticleCost-Effectiveness of Therapeutic Drug Monitoring: A Systematic ReviewTouw, D. J. PharmD, PhD*; Neef, C. PharmD, PhD†; Thomson, A. H. MSc, PhD‡; Vinks, A. A. PharmD, PhD, FCP§on behalf of the Cost-Effectiveness of TherapeuticAuthor Information Drug Monitoring Committee of the International Association for Therapeutic Drug Monitoring and Clinical Toxicology From the *Apotheek Haagse Ziekenhuizen, 2504 AC Den Haag, Netherlands; †Pharmacy Department, Medisch Spectrum Twente, Enschede, Netherlands; ‡Pharmacy Department, Western Infirmary, Glasgow, Scotland; and §Pediatric Pharmacology Research Unit, Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio. Received for publication January 23, 2004; accepted June 27, 2004. The authors have no vested interest in any of the products or methods discussed. Reprints: D. J. Touw, PharmD, PhD, Apotheek Haagse Ziekenhuizen, Postbus 43100, 2504 AC Den Haag, Netherlands (e-mail: [email protected]). Therapeutic Drug Monitoring: February 2005 - Volume 27 - Issue 1 - p 10-17 Buy Abstract There are a number of effective but highly toxic drugs that exhibit a narrow therapeutic index and marked interpatient pharmacokinetic variability. Individualized therapy with such drugs requires therapeutic drug monitoring (TDM) to obtain the desired clinical effects safely. Cost-effectiveness analysis in health care is still at an early stage of development, especially for TDM. A systematic review was carried out to document studies that have addressed the cost-effectiveness of TDM. The Cochrane database and Medline were searched. References identified by this approach were then searched manually for relevant articles. Very few studies have been performed that document the cost-effectiveness of TDM, and TDM has been demonstrated to be cost-effective only for aminoglycosides. For the other classes of drugs that are monitored, the rationale for TDM has been supported, but appropriate cost-effectiveness analyses have not been performed. Because the use of many of these drugs without TDM would increase the risk of under- or overdosing, emphasis should not be placed solely on cost-effectiveness but rather on how such interventions can be applied in the most cost-effective and clinically useful manner. © 2005 Lippincott Williams & Wilkins, Inc.