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Cost-effectiveness of linezolid versus vancomycin for hospitalised patients with complicated skin and soft-tissue infections in Germany

  • Dirk Schürmann
  • Sonja V. Sorensen
  • Erwin De Cock
  • Sandeep Duttagupta
  • Ansgar ReschEmail author
Original paper

Abstract

This study used a decision analytic model approach to evaluate the cost-effectiveness of linezolid versus vancomycin in the empirical treatment of complicated skin and soft-tissue infection (cSSTI) due to suspected methicillin-resistant Staphylococcus aureus (MRSA) from the German hospital and health care system perspective. Clinical probabilities were obtained from trial data, resource utilisation and MRSA prevalence rates were obtained through German physician interviews, and costs from published sources were applied to resource units. Outcomes included total cost/patient and cure. The estimated first-line cure rate for linezolid-treated patients was 90.1% versus 85.5% for vancomycin; total cure rates after two lines of treatment were 98.4% and 98.1%, respectively. Average total cost/episode was 8,232 € for linezolid versus 9,206 € for vancomycin. The model outcomes were sensitive to changes in length of stay (LOS), isolation days, rate of confirmed MRSA and price of linezolid. Linezolid was expected to result in a shorter intravenous treatment duration and shorter LOS that offset its higher acquisition cost versus vancomycin in cSSTI in Germany.

Keywords

Complicated skin and soft-tissue infections Cost-effectiveness MRSA Linezolid Vancomycin 

JEL Classification

I19 

Notes

Acknowledgments

This study was sponsored by Pfizer Inc. Dirk Schürmann has received honoraria for speaking at symposia organised on behalf of Pharmacia GmbH/Pfizer GmbH and has also received a consultancy fee pertaining to the use and clinical relevance of linezolid. Sonja V. Sorensen and Erwin De Cock have none to declare. Sandeep Duttagupta is employed by Pfizer Inc. Ansgar Resch is employed by Pfizer Deutschland GmbH. Editorial support was provided by Elizabeth Melby Wells of PAREXEL, Stamford, CT, USA and was funded by Pfizer Inc.

References

  1. 1.
    Nathwani, D., Moitra, S., Dunbar, J., Crosby, G., Peterkin, G., Davey, P.: Skin and soft tissue infections development of a collaborative management plan between community and hospital care. Int. J. Clin. Pract. 52, 456–460 (1998)Google Scholar
  2. 2.
    Tice, A.D., Poretz, D., Cook, F., Zinner, D., Strauss, M.J.: Medicare coverage of outpatient ambulatory intravenous antibiotic therapy: a program that pays for itself. Clin. Infect. Dis. 27, 1415–1421 (1998)CrossRefGoogle Scholar
  3. 3.
    Dykhuizen, R.S., Trent, R.J., Pacitti, D.P., Reid, T.M., Douglas, J.G., Smith, C.C.: An analysis of 900 consecutive admissions to a regional infection unit. J. Infect. 29, 189–193 (1994)CrossRefGoogle Scholar
  4. 4.
    Stevens, D.L., Smith, L.G., Bruss, J.B., et al.: Randomized comparison of linezolid (PNU-100766) versus oxacillin-dicloxacillin for treatment of complicated skin and soft tissue infections. Antimicrob. Agents Chemother. 44, 3408–3413 (2000)CrossRefGoogle Scholar
  5. 5.
    Swartz, M.N.: Cellulitis and superficial infections. In: Mandell, G., Douglas, R., Bennett, J. (eds.) Principles and Practice of Infectious Diseases-1990, pp. 796–807. Churchill Livingstone, New York (1992)Google Scholar
  6. 6.
    Raghavan, M., Linden, P.K.: Newer treatment options for skin and soft tissue infections. Drugs 64, 1621–1642 (2004)CrossRefGoogle Scholar
  7. 7.
    Tiemersma, E.W., Bronzwaer, S.L., Lyytikainen, O., et al.: Methicillin-resistant Staphylococcus aureus in Europe, 1999–2002. Emerg. Infect. Dis. 10, 1627–1634 (2004)Google Scholar
  8. 8.
    Jones, M.E., Karlowsky, J.A., Draghi, D.C., Thornsberry, C., Sahm, D.F., Nathwani D.: Epidemiology and antibiotic susceptibility of bacteria causing skin and soft tissue infections in the USA and Europe: a guide to appropriate antimicrobial therapy. Int. J. Antimicrob. Agents 22, 406–419 (2003)CrossRefGoogle Scholar
  9. 9.
    Paul-Ehrlich-Gesellschaft fur Chemotherapie: http://www.p-e-g.org/ag_resistenz/main.html. Accessed 01 Feb 2006
  10. 10.
    Cosgrove, S.E., Sakoulas, G., Perencevich, E.N., Schwaber, M.J., Karchmer, A.W., Carmeli Y.: Comparison of mortality associated with methicillin-resistant and methicillin-susceptible Staphylococcus aureus bacteremia: a meta-analysis. Clin. Infect. Dis. 36, 53–59 (2003)CrossRefGoogle Scholar
  11. 11.
    Lodise, T.P., McKinnon, P.S.: Clinical and economic impact of methicillin resistance in patients with Staphylococcus aureus bacteremia. Diagn. Microbiol. Infect. Dis. 52, 113–122 (2005)CrossRefGoogle Scholar
  12. 12.
    Reed, S.D., Friedman, J.Y., Engemann, J.J., et al.: Costs and outcomes among hemodialysis-dependent patients with methicillin-resistant or methicillin-susceptible Staphylococcus aureus bacteremia. Infect. Control Hosp. Epidemiol. 26, 175–183 (2005)CrossRefGoogle Scholar
  13. 13.
    Voss, A., Milatovic, D., Wallrauch-Schwarz, C., Rosdahl, V.T., Braveny I.: Methicillin-resistant Staphylococcus aureus in Europe. Eur. J. Clin. Microbiol. Infect. Dis. 13, 50–55 (1994)CrossRefGoogle Scholar
  14. 14.
    Centers for Disease Control and Prevention.: Update: Staphylococcus aureus with reduced susceptibility to vancomycin—United States, 1997. MMWR 46, 813–815 (1997)Google Scholar
  15. 15.
    Panlilio, A.L., Culver, D.H., Gaynes, R.P., et al.: Methicillin-resistant Staphylococcus aureus in U.S. hospitals, 1975–1991. Infect. Control Hosp. Epidemiol. 13, 582–586 (1992)CrossRefGoogle Scholar
  16. 16.
    Ploy, M.C., Grelaud, C., Martin, C., de Lumley, L., Denis F.: First clinical isolate of vancomycin-intermediate Staphylococcus aureus in a French hospital. Lancet 351, 1212 (1998)CrossRefGoogle Scholar
  17. 17.
    Wong, S.S., Ho, P.L., Woo, P.C., Yuen, K.Y.: Bacteremia caused by staphylococci with inducible vancomycin heteroresistance. Clin. Infect. Dis. 29, 760–767 (1999)CrossRefGoogle Scholar
  18. 18.
    Eliopoulos, G.M., Wennersten, C.B., Gold, H.S., Moellering, R.C. Jr: In vitro activities in new oxazolidinone antimicrobial agents against enterococci. Antimicrob. Agents Chemother. 40, 1745–1747 (1996)Google Scholar
  19. 19.
    Ford, C.W., Hamel, J.C., Wilson, D.M., et al.: In vivo activities of U-100592 and U-100766, novel oxazolidinone antimicrobial agents, against experimental bacterial infections. Antimicrob. Agents Chemother. 40, 1508–1513 (1996)Google Scholar
  20. 20.
    Swaney, S.M., Aoki, H., Ganoza, M.C., Shinabarger, D.L.: The oxazolidinone linezolid inhibits initiation of protein synthesis in bacteria. Antimicrob. Agents Chemother. 42, 3251–3255 (1998)Google Scholar
  21. 21.
    Zurenko, G.E., Yagi, B.H., Schaadt, R.D., et al.: In vitro activities of U-100592 and U-100766, novel oxazolidinone antibacterial agents. Antimicrob. Agents Chemother. 40, 839–845 (1996)Google Scholar
  22. 22.
    Yaldo, A.Z., Sullivan, J.L., Li Z.: Factors influencing physicians’ decision to discharge hospitalized patients infected with methicillin-resistant Staphylococcus aureus. Am. J. Health Syst. Pharm. 58, 1756–1759 (2001)Google Scholar
  23. 23.
    Stevens, D.L., Herr, D., Lampiris, H., Hunt, J.L., Batts, D.H., Hafkin, B., and the Linezolid MRSA Study Group: Linezolid versus vancomycin for the treatment of methicillin-resistant Staphylococcus aureus infections. Clin. Infect. Dis. 34, 1481–1490 (2002)CrossRefGoogle Scholar
  24. 24.
    Vinken A., Li Z., Balan D., Rittenhouse B., Wilke R., Nathwani D.: Economic evaluation of linezolid, flucloxacillin and vancomycin in the empirical treatment of cellulitis in UK hospitals: a decision analytic model. J. Hosp. Infect. 49 (Suppl A), S13–S24 (2001)CrossRefGoogle Scholar
  25. 25.
    Plosker, G.L., Figgitt, D.P.: Linezolid: a pharmacoeconomic review of its use in serious Gram-positive infections. Pharmacoeconomics 23, 945–964 (2005)CrossRefGoogle Scholar
  26. 26.
    Weigelt, J., Itani, K., Stevens, D., et al.: Linezolid versus vancomycin in treatment of complicated skin and soft tissue infections. Antimicrob. Agents Chemother. 49, 2260–2266 (2005)CrossRefGoogle Scholar
  27. 27.
    McKinnon, P.S., Sorensen, S.V., Liu, L.Z., Itani, K.M.: Impact of linezolid on economic outcomes and determinants of cost in a clinical trial evaluating patients with MRSA complicated skin and soft-tissue infections. Ann. Pharmacother. 40, 1017–1023 (2006)CrossRefGoogle Scholar
  28. 28.
    Itani, K.M., Weigelt, J., Li, J.Z., Duttagupta S.: Linezolid reduces length of stay and duration of intravenous treatment compared with vancomycin for complicated skin and soft tissue infections due to suspected or proven methicillin-resistant Staphylococcus aureus (MRSA). Int. J. Antimicrob. Agents 26, 442–448 (2005)CrossRefGoogle Scholar
  29. 29.
    Weigelt, J., Kaafarani, H.M.A., Itani, K.M.F., Swanson, R.N.: Linezolid eradicates MRSA better than vancomycin from surgical-site infections. Am. J. Surg. 188, 760–766 (2004)CrossRefGoogle Scholar
  30. 30.
    Deutsche Krankenhausgesellschaft Tarif der Deutschen Krankenhausgesellschaft für die Abrechnung erbrachter Leistungen und fur die Kostenerstattung vom Artz an das Krankenhaus DKG-NT Band I. W. Kohlhammer Verlag. Juli 2002Google Scholar
  31. 31.
    Einheitlicher Bewertungsmaßstab (EBM), Stand 1 Oktober 2001, Dienstauflage der Kassenärztlichen Bundesvereinigung, Deutscher Arzte Verlag, Köln (2001)Google Scholar
  32. 32.
    Kassenärztliche Vereinigung Westfalen-Lippe (KVWL): Honorarverteilungsvertrag (2004)Google Scholar
  33. 33.
    Institut für das Entgeltsystem im Krankenhaus gGmbH: Abschlussbericht. Weiterentwicklung des G-DRG-Systems für das Jahr 2004. Klassifikation, Katalog und Bewertungsrelationen. Band II: Fallpauschalen-Katalog, Klinische Profile, Kostenprofile, 19 December 2003. http://inek.customer.msim.de/service/download/Projektbericht2003/Abschlussbericht_G-DRG_V2004_0312191400_BII.pdf. 01 Feb 2006
  34. 34.
    Popp, W., Hilgenhoner, M., Leisebein, T., Muller H.: Personalkosten durch Isolierungsmassnahmen von MRSA-Patienten. Gesundh. Okon. Qual. Manage. 8, 187–190 (2003)CrossRefGoogle Scholar
  35. 35.
    Rote Liste® Service GmbH: Rote Liste. http://www.rote-liste.de. 30 June 2004
  36. 36.
    World Health Organization: International statistical classification of diseases and related health problems. In: Tenth Revision, German Modification (ICD-10-GM), Version 2003. German Institute for Medical Documentation and Information, Cologne, Germany (2003)Google Scholar
  37. 37.
    Universitätsklinikum Münster: Westfälische Wilhelms-Universität Münster. Medizincontrolling/DRG Research Group. WebGrouper: G-DRG 2004/2005. http://drg.uni-muenster.de/de/webgroup/m.webgroup.php. 01 Feb 2006
  38. 38.
    Vinken, A.G., Li, J.Z., Balan, D.A., Rittenhouse, B.E., Willke, R.J., Goodman C.: Comparison of linezolid with oxacillin or vancomycin in the empiric treatment of cellulitis in US hospitals. Am. J. Ther. 10, 264–274 (2003)CrossRefGoogle Scholar
  39. 39.
    Li, Z., Willke, R.J., Pinto, L.A., et al.: Comparison of length of hospital stay for patients with known or suspected methicillin-resistant Staphylococcus species infections treated with linezolid or vancomycin: a randomized, multicenter trial. Pharmacotherapy 21, 263–274 (2001)CrossRefGoogle Scholar
  40. 40.
    Ono, R., Wedemeyer, D.J.: Assessing the validity of the Delphi technique. Futures 26, 289–304 (1994)CrossRefGoogle Scholar
  41. 41.
    Walker, A.M., Selfe, J.: The Delphi method: a useful tool for the allied health researcher. Br. J. Ther. Rehabil. 3, 677–681 (1996)Google Scholar
  42. 42.
    Wernitz, M.H., Keck, S., Swidsinski, S., Schulz, S., Veit, S.K.: Cost analysis of a hospital-wide selective screening programme for methicillin-resistant Staphylococcus aureus (MRSA) carriers in the context of diagnosis related groups (DRG) payment. Clin. Microbiol. Infect. 11, 466–471 (2005)CrossRefGoogle Scholar
  43. 43.
    Schreyögg J., Stargardt, T., Tiemann, O., Busse R.: Methods to determine reimbursement rates for diagnosis related groups (DRG): a comparison of nine European countries. Health Care Manage. Sci. 9, 215–223 (2006)CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • Dirk Schürmann
    • 1
  • Sonja V. Sorensen
    • 2
  • Erwin De Cock
    • 3
  • Sandeep Duttagupta
    • 4
  • Ansgar Resch
    • 5
    Email author
  1. 1.Department of Internal Medicine/Infectious Diseases and Pulmonary MedicineCharité, Universitätsmedizin BerlinBerlinGermany
  2. 2.Center for Health Economics, Epidemiology and Science PolicyUnited BioSource CorporationBethesdaUSA
  3. 3.Health Care Analytics Group-EuropeUnited BioSource CorporationBarcelonaSpain
  4. 4.Pfizer Inc.New YorkUSA
  5. 5.Pfizer Deutschland GmbHKarlsruheGermany

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