Viriya HantrakunWirongrong ChierakulPloenchan ChetchotisakdSiriluck AnunnatsiriBart J. CurrieSharon J. PeacockNicholas P.J. DayPhaik CheahDirek LimmathurotsakulYoel LubellMahidol UniversityKhon Kaen UniversityRoyal Darwin HospitalUniversity of CambridgeNuffield Department of Clinical Medicine2018-11-232018-11-232015-01-01Transactions of the Royal Society of Tropical Medicine and Hygiene. Vol.109, No.6 (2015), 416-41818783503003592032-s2.0-84939524187https://repository.li.mahidol.ac.th/handle/20.500.14594/36171© The Author 2015. Background: Melioidosis is a common community-acquired infectious disease in northeast Thailand associated with overall mortality of approximately 40% in hospitalized patients, and over 70% in severe cases. Ceftazidime is recommended for parenteral treatment in patients with suspected melioidosis. Meropenem is increasingly used but evidence to support this is lacking. Methods: A decision tree was used to estimate the cost-effectiveness of treating non-severe and severe suspected acute melioidosis cases with either ceftazidime or meropenem. Results: Empirical treatment with meropenem is likely to be cost-effective providing meropenem reduces mortality in severe cases by at least 9% and the proportion with subsequent culture-confirmed melioidosis is over 20%. Conclusions: In this context, treatment of severe cases with meropenem is likely to be cost-effective, while the evidence to support the use of meropenem in non-severe suspected melioidosis is not yet available.Mahidol UniversityImmunology and MicrobiologyArticleSCOPUS10.1093/trstmh/trv002