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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.
Acknowledgments
The authors thank Gaurang Bhatt, formerly of Pfizer Inc., and Xin Gao, of Pharmerit International, for their work on early development of this model. This study was sponsored by Pfizer Inc. Pharmerit North America LLC received research funding from Pfizer Inc. for development of the model. Editorial support was provided by Ray Beck, Jr, of Engage Scientific Solutions and was funded by Pfizer Inc.
Disclosure
DAP and JS are employees of Pharmerit but received no funding for development of the manuscript. BW, CP, and CC are employees of Pfizer Inc. AM has received honoraria from Pfizer for speaking engagements but declares no other potential financial competing interests.