Modeling the economic impact of linezolid versus vancomycin in confirmed nosocomial pneumonia caused by methicillin-resistant Staphylococcus aureus
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- 作者：Dipen A Patel (121)
Andrew F Shorr (122)
Jean Chastre (123)
Michael Niederman (124)
Andrew Simor (125)
Jennifer M Stephens (121)
Claudie Charbonneau (126)
Xin Gao (121)
Dilip Nathwani (127)
121. Pharmerit International ; 4350 East West Highway ; Suite 430 ; Bethesda ; MD ; 20814 ; USA
122. Department of Pulmonary & Critical Care Medicine ; Washington Hospital Center ; 110 Irving St NW ; Washington ; DC ; 20010 ; USA
123. Service de R茅animation M茅dicale Institut de Cardiologie Groupe ; Hospitalier Piti茅-Salp锚tri猫re ; 47-83 boulevard de l鈥橦么pital ; 75651 ; Paris Cedex 13 ; France
124. Department of Medicine ; Winthrop-University Hospital ; 222 Station Plaza N ; Suite 509 ; Mineola ; NY ; 11501 ; USA
125. Department of Microbiology ; Sunnybrook Health Sciences Centre ; B121-2075 Bayview Ave. ; Toronto ; ON ; M4N 3M5 ; Canada
126. Outcomes Research-Europe Infectious Diseases ; Pfizer International Operations Specialty ; Business Unit 23-25 ; avenue du Dr Lannelongue ; F-75668 ; Paris Cedex 14 ; France
127. Ninewells Hospital & Medical School ; Ward 42 ; East Block ; Dundee ; DD19SY ; UK - 刊名：Critical Care
- 出版年：2014
- 出版时间：August 2014
- 年：2014
- 卷：18
- 期：4
- 全文大小：492 KB
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RED BOOK. Thomson Reuters, Montvale, NJ - 刊物主题：Intensive / Critical Care Medicine; Emergency Medicine;
- 出版者：BioMed Central
- ISSN：1364-8535
文摘
Introduction We compared the economic impacts of linezolid and vancomycin for the treatment of hospitalized patients with methicillin-resistant Staphylococcus aureus (MRSA)鈥揷onfirmed nosocomial pneumonia. Methods We used a 4-week decision tree model incorporating published data and expert opinion on clinical parameters, resource use and costs (in 2012 US dollars), such as efficacy, mortality, serious adverse events, treatment duration and length of hospital stay. The results presented are from a US payer perspective. The base case first-line treatment duration for patients with MRSA-confirmed nosocomial pneumonia was 10聽days. Clinical treatment success (used for the cost-effectiveness ratio) and failure due to lack of efficacy, serious adverse events or mortality were possible clinical outcomes that could impact costs. Cost of treatment and incremental cost-effectiveness per successfully treated patient were calculated for linezolid versus vancomycin. Univariate (one-way) and probabilistic sensitivity analyses were conducted. Results The model allowed us to calculate the total base case inpatient costs as $46,168 (linezolid) and $46,992 (vancomycin). The incremental cost-effectiveness ratio favored linezolid (versus vancomycin), with lower costs ($824 less) and greater efficacy (+2.7% absolute difference in the proportion of patients successfully treated for MRSA nosocomial pneumonia). Approximately 80% of the total treatment costs were attributed to hospital stay (primarily in the intensive care unit). The results of our probabilistic sensitivity analysis indicated that linezolid is the cost-effective alternative under varying willingness to pay thresholds. Conclusion These model results show that linezolid has a favorable incremental cost-effectiveness ratio compared to vancomycin for MRSA-confirmed nosocomial pneumonia, largely attributable to the higher clinical trial response rate of patients treated with linezolid. The higher drug acquisition cost of linezolid was offset by lower treatment failure鈥搑elated costs and fewer days of hospitalization.