Cost-Effectiveness of Linezolid vs Vancomycin in Suspected Methicillin-Resistant Staphylococcus aureus Nosocomial Pneumonia in Germany
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The oxazolidinone antibiotic linezolid has demonstrated efficacy in treating infections caused by methicillin-resistant Staphylococcus aureus (MRSA). In a retrospective analysis of two prospective randomized clinical trials in patients with nosocomial pneumonia (NP), initial therapy with linezolid produced significantly better clinical cure and survival rates than vancomycin in the subset of patients with documented MRSA infection. This study was designed to evaluate the economic impact of these clinical outcomes from the perspective of the German health care system to determine the use of these regimens in the light of limited resources and rising costs.
A decision–analytic model using clinical trial data was developed to examine the costs and outcomes of treatment with linezolid or vancomycin in hospitalized patients with NP caused by suspected MRSA. The model followed an average patient from initiation of empiric treatment until treatment success, death, or second-line treatment failure. Local treatment patterns and resource use were obtained from a Delphi panel. Costs were taken from published sources. Outcomes included total cost per patient, cost per additional cure, cost per death avoided, and cost per life-year gained.
The model calculated that linezolid was associated with an 8.7% higher cure rate compared with vancomycin (73.6% vs 64.9%, respectively). Average total costs per episode for linezolid- and vancomycin-treated patients were €12,829 and €12,409, respectively. Death rates were 13.2% lower with linezolid than with vancomycin (20.7% vs 33.9%), resulting in an average of 2.3 life-years gained per linezolid-treated patient in a 65-year-old cohort (14.0 life-years vs 11.7 life-years). With linezolid, incremental costs per death avoided and per patient cured were €3,171 and €4,813, respectively. The base case estimated a similar mean length of stay for both drugs (11.2 vs 10.8 days). One-way sensitivity analyses did not change the overall results.
The model estimated a higher clinical cure (+8.7%) and survival (+13.2%) for linezolid compared with vancomycin at an incremental cost of €420 per treatment episode. The cost–benefit profile suggests that linezolid could be considered a cost-effective alternative to vancomycin in the treatment of patients with NP caused by suspected MRSA in Germany.
KeywordsVancomycin Linezolid Nosocomial Pneumonia Delphi Panel Infect Control Hosp
- 2.Vincent JL, Bihari DJ, Suter PM, Bruining HA, White J, Nicolas-Chanoin MH, Wolff M, Spencer RC, Hemmer M: The prevalence of nosocomial infection in intensive care units in Europe. Results of the European Prevalence of Infection in Intensive Care (EPIC) Study. EPIC International Advisory Committee. JAMA 1995; 274: 639–644.PubMedCrossRefGoogle Scholar
- 6.Diekema DJ, Pfaller MA, Schmitz FJ, Smayevsky J, Bell J, Jones RN, Beach M and the SENTRY Participants Group: Survey of infections due to Staphylococcus species: frequency of occurrence and antimicrobial susceptibility of isolates collected in the United States, Canada, Latin America, Europe, and the Western Pacific region for the SENTRY Antimicrobial Surveillance Program, 1997–1999. Clin Infect Dis 2001; 32: s114–s132.PubMedCrossRefGoogle Scholar
- 7.European Antimicrobial Resistance Surveillance System (EARSS) Database: National Institute of Public Health and the Environment. RIVM, Department of Infectious Disease Epidemiology, Bilthoven, The Netherlands; 2005. Available at http://www.earss.rivm.nl/PAGINA/interwebsite/database.html Google Scholar
- 12.American Thoracic Society Infectious Diseases Society of America Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med 2005; 15: 388–416.Google Scholar
- 17.Cepeda JA, Whitehouse T, Cooper B, Hails J, Jones K, Kwaku F, Taylor L, Hayman S, Shaw S, Kibbler C, Shulman R, Singer M, Wilson AP: Linezolid versus teicoplanin in the treatment of Gram-positive infections in the critically ill: a randomized, double-blind, multicentre study. J Antimicrob Chemother 2004; 53: 345–355.PubMedCrossRefGoogle Scholar
- 18.Rubinstein E, Cammarata S, Oliphant T, Wunderink R and the Linezolid Nosocomial Pneumonia Study Group: Linezolid (PNU-100766) versus vancomycin in the treatment of hospitalized patients withnosocomial pneumonia: a randomized, double-blind, multicenter study. Clin Infect Dis 2001; 32: 402–412.PubMedCrossRefGoogle Scholar
- 19.Wunderink RG, Cammarata SK, Oliphant TH, Kollef MH, and the Linezolid Nosocomial Pneumonia Study Group: Continuation of a randomized, double-blind, multicenter study of linezolid versus vancomycin in the treatment of patients with nosocomial pneumonia. Clin Ther 2003; 25: 980–992.PubMedCrossRefGoogle Scholar
- 25.Zanetti G, Bally F, Greub G, Garbino J, Kinge T, Lew D, Romand JA, Bille J, Aymon D, Stratchounski L, Krawczyk L, Rubinstein E, Schaller MD, Chiolero R, Glauser MP, Cometta A, and the Cefepime Study Group: Cefepime versus imipenem-cilastatin for treatment of nosocomial pneumonia in intensive care unit patients: a multicenter, evaluator-blind, prospective, randomized study. Antimicrob Agents Chemother 2003; 47: 3442–3447.PubMedCrossRefGoogle Scholar
- 26.Rote Liste® Service GmbH. Rote Liste. Available at: http://www.rote-liste.de. Accessed 27 Feb 2007.
- 27.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, July 2005.Google Scholar
- 28.Einheitlicher Bewertungsmaßstab (EBM). Kassenärztliche Bundesvereinigung Berlin, erstellt am 22.03.2007 (V. 7.0).Google Scholar
- 29.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. Available at: http://inek.customer.msim.de/service/download/Projektbericht2003/Abschlussbericht_G-DRG_V2004_0312191400_BII.pdf. Accessed 1 Feb 2006.
- 30.Verband der Privaten Krankenversicherunge.V. Die Private Krankenversicherung. Zahlenbericht 2002/2003. Köln.Google Scholar
- 31.OECD Health Data 2002: a comparative analysis of 30 countries. Organisation for Economic Co-operation and Development (OECD), Paris. Available at: http://www.OECD.org