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Pharmacy World and Science

, Volume 27, Issue 6, pp 459–464 | Cite as

Pharmacoeconomic Evaluation of Linezolid Versus Teicoplanin in Bacteremia by Gram-Positive Microorganisms*

  • Santiago GrauEmail author
  • Javier Mateu-de Antonio
  • Javier Soto
  • Mónica Marín-Casino
  • Esther Salas
Research Article

Abstract

Objective:

The objective of this study was to compare the efficiency of linezolid versus teicoplanin in the treatment of bacteremia produced by Gram-positive microorganisms through a pharmacoeconomic analysis based on clinical results obtained from a previous clinical trial.

Methods:

We applied an analysis of cost-effectiveness elaborated through a pharmacoeconomic model. We defined each unit of effectiveness as ‘each successfully cured of infections with bacteremia.’ We used the program Pharma-Decision (version Hospital 1.1) that allows to build interactive pharmacoeconomic models. Effectiveness data of both antibiotics were obtained from a published clinical trial, while resources consumed were obtained from the same source and from a consensus provided by a local expert panel. Only direct costs were included in the analysis without taking into consideration indirect costs. The perspective chosen was hospital assistance and the time horizon was set to 28 days. All costs are expressed in Euros.

Results:

Linezolid demonstrated a better clinical outcome with less associated costs compared to teicoplanin (88.5 versus 56.7% of cured patients and 5,557.04 versus 6,327.43 € per treated patient, respectively), thus resulting in a lower cost-effectiveness ratio for linezolid versus teicoplanin (6,279.1 versus 11,159.5 € per cured patient with a 95% CI of 5,960.2–6,510.4 and 10,865.2–12,647.3, respectively) which results in a the dominant position for linezolid. The sensitivity analysis showed that linezolid was always the most efficient option even when modifying the value of variables with higher uncertainty.

Conclusions:

Linezolid is a more efficient option than teicoplanin because it presents higher rate of effectiveness with lower consumption of resources, thus being a dominant alternative in the treatment of Gram-positive infection with bacteremia.

Keywords

Cost-effectiveness analysis Gram-positive bacteremia Linezolid Pharmacoeconomics Teicoplanin 

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References

  1. 1.
    Oteo, J Cruchaga, S Campos, J Sáez, JA Baquero, F Spanish members of the European Group of Antimicrobial Resistance Surveillance System (EARSS)2002Resistencia a antibióticos en Staphylococcus aureus aislados de sangre de 31 hospitales españoles de la Red Europea de Vigilancia de Resistencia a Antibióticos (2000)Med Clin (Barc)1193615Google Scholar
  2. 2.
    Asensio, A Cantón, R Vaqué, J Rosselló, J Arribas, JL EPINE group2002Etiología de las infecciones hospitalarias en España (EPINE, 1990–1999)Med Clin (Barc)11872530Google Scholar
  3. 3.
    Cantón R, Asensio A.. Prevalencia del uso de antimicrobianos. In Vaqué J, Roselló J, editors. Evolución de la prevalencia de las infecciones nosocomiales en hospitales españoles. EPINE 1990–1999; 299–336Google Scholar
  4. 4.
    EARSS Management Team2000European antimicrobial resistance surveillance systemEARSS Newsletter318Google Scholar
  5. 5.
    Cantón, R, Mir, N, Martínez-Ferrer, M, Sánchez del Sanz, B, Soler, I, Baquero, F 1999Estudio prospectivo de Staphylococcus aureus con sensibilidad disminuída a los glucopéptidosRev Esp Quimioter124853PubMedGoogle Scholar
  6. 6.
    Aymerich, M, García Altes, A, Jovell, AJ 1999Las resistencias bacterianas: ¿algo más que un problema clínico? La resistencia del enterococo a la vancomicina como ejemploMed Clin (Barc)1125535Google Scholar
  7. 7.
    Schentag, JJ 2001Antimicrobial management strategies for bacterial Gram-positive resistance in the intensive care unitCrit Care Med291007Google Scholar
  8. 8.
    Clemett, D, Markham, A 2000LinezolidDrugs5981528PubMedGoogle Scholar
  9. 9.
    Bain, KT, Wiftbrodt, EI 2001Linezolid for the treatment of resistant Gram-positive cocciAnn Pharmacother3556675CrossRefPubMedGoogle Scholar
  10. 10.
    Diekema, DJ, Jones, RN 2001Oxazolidinone antibioticsLancet358197582CrossRefPubMedGoogle Scholar
  11. 11.
    Perry, CM, Jarvis, B 2001Linezolid. A review of its uses in the management of serious Gram-positive infectionsDrugs6152551PubMedGoogle Scholar
  12. 12.
    Li, Z, Willke, RJ, Pinto, LA,  et al. 2001Comparison of length of hospital stay for patients with known or suspected methicillin-resistant Staphylococcus species infections treated with linezolid or vancomycin. A randomised, multicenter trialPharmacotherapy2126374PubMedGoogle Scholar
  13. 13.
    Wilcox M, Tang L, Hafkin B.. Linezolid versus teicoplanin for the treatment of hospitalized patients with Gram positive infections poster 1481. 41st interscience Conference on Antimicrobial Agents and Chemotherapy. Chicago, December 2001Google Scholar
  14. 14.
    Willke, RJ, Glick, HAS, Li, JZ, Rittenhouse, BE 2002Effects of linezolid on hospital length of stay compared with vancomycin in treatments of methicillin-resistant Staphylococcus infectionsInt J Tec Assess Health Care1854054Google Scholar
  15. 15.
    Li, J, Balan, D, Willke, R,  et al. 2002Comparison of hospital resource uses between linezolid and teicoplanin for the treatment of bacterial Gram-positive infections: results of a multicentre trial. AbstractClin Microbiol infec883Google Scholar
  16. 16.
    Wilcox, M, Nathwani, D, Dryden, M 2004Linezolid compared with teicoplanin for the treatment of suspected or proven Gram-positive infectionsJ Antimicrob Chemother5333544PubMedGoogle Scholar
  17. 17.
    Lopez, H, Li, JZ, Balan, DA,  et al. 2003Hospital resource use and cost of treatment with linezolid versus teicoplanin for treatment of serious Gram-positive bacterial infections among hospitalized patients from South America and Mexico: results from a multicenter trialClin Ther25184671CrossRefPubMedGoogle Scholar
  18. 18.
    Nathwani, D, Li, JZ, Balan, DA, Willke, RJ, Rittenhouse, BE, Mozaffari, E,  et al. 2004An economic evaluation of a European cohort from a multinational trial of linezolid versus teicoplanin in serious Gram-positive bacterial infections: the importance of treatment setting in evaluating treatment effectsInt J Antimicrob Agents2331524PubMedGoogle Scholar
  19. 19.
    Delgado, G, Neuhauser, MM, Bearden, DI, Dazinger, LH 2000Quinupristin–dalfopristin: an overviewPharmacotherapy20146985PubMedGoogle Scholar
  20. 20.
    U.S. Department of Health and Human Services. Food and Drug Administration. Center for Drug Evaluation and Research. NDA-I1: NDA approval letter, 2003. Available at http://www.fda. gov/cder/foi/appletter/2003/21572ltr.pdf. Accessed February 2, 2004Google Scholar
  21. 21.
    Wunderink, RG, Cammarata, SK, Oliphant, TH, Kollef, MH 2003Continuation of a randomized, double-blind, multicenter study of linezolid versus vancomycin in the treatment of patients with nosocomial pneumoniaClin Ther2598092CrossRefPubMedGoogle Scholar
  22. 22.
    Wunderink, RG, Rello, J, Cammarata, SK, Croos-Dabrera, RV, Kollef, MH 2003Linezolid versus vancomycin. Analysis of two double-blind studies of patients with methicillin-resistant Staphylococcus aureus nosocomial pneumoniaChest124178997PubMedGoogle Scholar
  23. 23.
    Kollef MH, Rello J, Cammarata SK, Croos-Dabrera RV, Wunderink RG. Clinical cure and survival in Gram-positive ventilator-associated pneumonia: retrospective analysis of two double-blind studies comparing linezolid with vancomycin. Intens Care Med 2004; 30: 388–94; published online 9 January 2004. DOI: 10.1007/s00134-003-2088-1Google Scholar
  24. 24.
    Li, JZ, Willke, RJ, Rittenhouse, BE, Glick, HAS 2002Approaches to analysis of length of hospital stay related to antibiotic therapy in a randomised clinical trial: for linezolid versus vancomycin treatment of known or suspected methicillin-resistant Staphylococcus species infectionsPharmacotherapy2245s54sPubMedGoogle Scholar
  25. 25.
    Vinken, To, Li, Z, Bleat, D, Rittenhouse, B, Willke, R, Nathwani, D 2001Economic evaluation of linezolid, flucoxacillin and vancomycin in the empirical treatment of cellulitis in UK hospitals: a decision analytical modelJ Hosp Infect49s1324PubMedGoogle Scholar
  26. 26.
    Shorr, AF, Susla, GM, Kollef, MH 2004Linezolid for treatment of ventilator-associated pneumonia: a cost-effective alternative to vancomycinCrit Care Med3213743PubMedGoogle Scholar
  27. 27.
    Cepeda, JA, Whitehouse, T, Cooper, B,  et al. 2004Linezolid versus teicoplanin in the treatment of Gram-positive infections in the critically ill: a randomized, double-blind, multicentre studyJ Antimicrob Chemother5334555CrossRefPubMedGoogle Scholar
  28. 28.
    Wilson, APR, Grüneberg, RN, Neu, H 1994A critical review of the dosage of teicoplanin in Europe and the USAInt J Antimicrob Agents4s130Google Scholar
  29. 29.
    Drummond, MF, Richardson, WS, O’Brien, BJ, Levine, M, Heyland, D 1997Users guides to medical the literature. XIII How to uses an article on economic clinical analysis of practiceJ Am Med Assoc27715527CrossRefGoogle Scholar
  30. 30.
    Del Campo, R, Tenorio, C, Zarazaga, M, Gómez-Lus, R, Baquero, F, Torres, C 2001Detection of to single vanA-containing Enterococcus faecalis done in hospitals in different regions in SpainJ Antimicrob Chemother4873548CrossRefGoogle Scholar
  31. 31.
    Normark, BH, Novak, R, Örtquist, A, Källenius, G, Tuomanen, E, Normark, S 2001Clinical isolates of Streptococcus pneumoniae that exhibit tolerance of vancomycinClin Infect Dis325528PubMedGoogle Scholar

Copyright information

© Springer 2005

Authors and Affiliations

  • Santiago Grau
    • 1
    Email author
  • Javier Mateu-de Antonio
    • 1
  • Javier Soto
    • 2
  • Mónica Marín-Casino
    • 1
  • Esther Salas
    • 1
  1. 1.Pharmacy DepartmentHospital del MarBarcelonaSpain
  2. 2.Pharmacoepidemiology and Pharmacoeconomics DepartmentMedical UnitMadridSpain

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