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An economic model to compare linezolid and vancomycin for the treatment of confirmed methicillin-resistant Staphylococcus aureus nosocomial pneumonia in Germany.

Patel DA, Michel A, Stephens J, Weber B, Petrik C, Charbonneau C - Infect Drug Resist (2014)

Bottom Line: The incremental cost-effectiveness ratio favored linezolid (versus vancomycin), with marginally lower costs (by €123) and greater efficacy (+2.7% absolute difference in the proportion of patients successfully treated for MRSA NP).Sensitivity analysis yielded similar results.The model results show that linezolid is a cost-effective alternative to vancomycin for MRSA-confirmed NP, largely attributable to the higher clinical response rate of patients treated with linezolid.

View Article: PubMed Central - PubMed

Affiliation: Health Economic and Outcomes Research, Pharmerit International, Bethesda, MD, USA.

ABSTRACT

Background: Across Europe, methicillin-resistant Staphylococcus aureus (MRSA) is considered to be the primary cause of nosocomial pneumonia (NP). In Germany alone, approximately 14,000 cases of MRSA-associated NP occur annually, which may have a significant impact on health care resource use and associated economic costs. The objective of this study was to investigate the economic impact of linezolid compared with that of vancomycin in the treatment of hospitalized patients with MRSA-confirmed NP in the German health care system.

Methods: A 4-week decision tree model incorporated published data and expert opinion on clinical parameters, resource use, and costs (2012 euros) was constructed. The base case first-line treatment duration for patients with MRSA-confirmed NP was 10 days. Treatment success (survival), failure due to lack of efficacy, serious adverse events, and mortality were possible outcomes that could impact costs. Alternate scenarios were analyzed, such as varying treatment duration (7 or 14 days) or treatment switch due to a serious adverse event/treatment failure (at day 5 or 10).

Results: The model calculated total base case inpatient costs of €15,116 for linezolid and €15,239 for vancomycin. The incremental cost-effectiveness ratio favored linezolid (versus vancomycin), with marginally lower costs (by €123) and greater efficacy (+2.7% absolute difference in the proportion of patients successfully treated for MRSA NP). Approximately 85%-87% of the total treatment costs were attributed to hospital stay (primarily in the intensive care unit). Sensitivity analysis yielded similar results.

Conclusion: The model results show that linezolid is a cost-effective alternative to vancomycin for MRSA-confirmed NP, largely attributable to the higher clinical response rate of patients treated with linezolid.

No MeSH data available.


Related in: MedlinePlus

Base-case model results. Linezolid dominates vancomycin in incremental cost effectiveness ratio, based upon (A) total medical costs (outpatient costs for both drugs was €0) and (B) proportion of successfully treated patients.Abbreviations: ICU, intensive care unit; SAE, serious adverse event.
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f2-idr-7-273: Base-case model results. Linezolid dominates vancomycin in incremental cost effectiveness ratio, based upon (A) total medical costs (outpatient costs for both drugs was €0) and (B) proportion of successfully treated patients.Abbreviations: ICU, intensive care unit; SAE, serious adverse event.

Mentions: Under the model (Tables 1 and 2) base case settings (with no empiric treatment, a 10-day treatment duration and discontinuation or switch of therapy possible after 7 days), the total inpatient (medical plus drug) costs were €15,116 for linezolid and €15,239 for vancomycin (Figure 2). Although the drug costs were €622 higher for linezolid compared with vancomycin, medical costs associated with linezolid were €744 lower with linezolid than with vancomycin. Overall, linezolid “dominated” vancomycin because of the former’s marginally lower costs (by €123 and greater effectiveness [+2.7% absolute difference in proportion of successfully treated patients]). The estimated overall proportion of successfully treated patients (over first-line and second-line treatment) was 62.9% and 60.2% for linezolid and vancomycin, respectively, and the total cost per successfully treated patient was €24,039 (linezolid) and €25,318 (vancomycin).


An economic model to compare linezolid and vancomycin for the treatment of confirmed methicillin-resistant Staphylococcus aureus nosocomial pneumonia in Germany.

Patel DA, Michel A, Stephens J, Weber B, Petrik C, Charbonneau C - Infect Drug Resist (2014)

Base-case model results. Linezolid dominates vancomycin in incremental cost effectiveness ratio, based upon (A) total medical costs (outpatient costs for both drugs was €0) and (B) proportion of successfully treated patients.Abbreviations: ICU, intensive care unit; SAE, serious adverse event.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4216023&req=5

f2-idr-7-273: Base-case model results. Linezolid dominates vancomycin in incremental cost effectiveness ratio, based upon (A) total medical costs (outpatient costs for both drugs was €0) and (B) proportion of successfully treated patients.Abbreviations: ICU, intensive care unit; SAE, serious adverse event.
Mentions: Under the model (Tables 1 and 2) base case settings (with no empiric treatment, a 10-day treatment duration and discontinuation or switch of therapy possible after 7 days), the total inpatient (medical plus drug) costs were €15,116 for linezolid and €15,239 for vancomycin (Figure 2). Although the drug costs were €622 higher for linezolid compared with vancomycin, medical costs associated with linezolid were €744 lower with linezolid than with vancomycin. Overall, linezolid “dominated” vancomycin because of the former’s marginally lower costs (by €123 and greater effectiveness [+2.7% absolute difference in proportion of successfully treated patients]). The estimated overall proportion of successfully treated patients (over first-line and second-line treatment) was 62.9% and 60.2% for linezolid and vancomycin, respectively, and the total cost per successfully treated patient was €24,039 (linezolid) and €25,318 (vancomycin).

Bottom Line: The incremental cost-effectiveness ratio favored linezolid (versus vancomycin), with marginally lower costs (by €123) and greater efficacy (+2.7% absolute difference in the proportion of patients successfully treated for MRSA NP).Sensitivity analysis yielded similar results.The model results show that linezolid is a cost-effective alternative to vancomycin for MRSA-confirmed NP, largely attributable to the higher clinical response rate of patients treated with linezolid.

View Article: PubMed Central - PubMed

Affiliation: Health Economic and Outcomes Research, Pharmerit International, Bethesda, MD, USA.

ABSTRACT

Background: Across Europe, methicillin-resistant Staphylococcus aureus (MRSA) is considered to be the primary cause of nosocomial pneumonia (NP). In Germany alone, approximately 14,000 cases of MRSA-associated NP occur annually, which may have a significant impact on health care resource use and associated economic costs. The objective of this study was to investigate the economic impact of linezolid compared with that of vancomycin in the treatment of hospitalized patients with MRSA-confirmed NP in the German health care system.

Methods: A 4-week decision tree model incorporated published data and expert opinion on clinical parameters, resource use, and costs (2012 euros) was constructed. The base case first-line treatment duration for patients with MRSA-confirmed NP was 10 days. Treatment success (survival), failure due to lack of efficacy, serious adverse events, and mortality were possible outcomes that could impact costs. Alternate scenarios were analyzed, such as varying treatment duration (7 or 14 days) or treatment switch due to a serious adverse event/treatment failure (at day 5 or 10).

Results: The model calculated total base case inpatient costs of €15,116 for linezolid and €15,239 for vancomycin. The incremental cost-effectiveness ratio favored linezolid (versus vancomycin), with marginally lower costs (by €123) and greater efficacy (+2.7% absolute difference in the proportion of patients successfully treated for MRSA NP). Approximately 85%-87% of the total treatment costs were attributed to hospital stay (primarily in the intensive care unit). Sensitivity analysis yielded similar results.

Conclusion: The model results show that linezolid is a cost-effective alternative to vancomycin for MRSA-confirmed NP, largely attributable to the higher clinical response rate of patients treated with linezolid.

No MeSH data available.


Related in: MedlinePlus