Health Economic Evaluation of Patients Treated for Nosocomial Pneumonia Caused by Methicillin-resistant Staphylococcus aureus : Secondary Analysis of a Multicenter Randomized Clinical Trial of Vancomycin and Linezolid

• Published in: Clinical therapeutics 2014-09, Vol.36 (9), p.1233-1243.e1
• Main Authors: Niederman, Michael S., MD, Chastre, Jean, MD, Solem, Caitlyn T., PhD, Wan, Yin, MS, Gao, Xin, PhD, Myers, Daniela E., MPH, Haider, Seema, MSc, Li, Jim Z., MD, PhD, Stephens, Jennifer M., PharmD
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents - economics; Anti-Bacterial Agents - therapeutic use; Cost-Benefit Analysis; cost-effectiveness; Cross Infection - drug therapy; Cross Infection - economics; Double-Blind Method; Drug Costs; economics; Female; Health Resources - economics; Health Resources - utilization; Humans; Internal Medicine; Linezolid - economics; Linezolid - therapeutic use; Male; Medical Education; Methicillin-Resistant Staphylococcus aureus; Middle Aged; MRSA; nosocomial pneumonia; outcomes; Pneumonia, Staphylococcal - drug therapy; Pneumonia, Staphylococcal - economics; Pneumonia, Staphylococcal - microbiology; Pneumonia, Ventilator-Associated - drug therapy; Pneumonia, Ventilator-Associated - economics; Renal Dialysis - economics; renal failure; Renal Insufficiency - economics; Renal Insufficiency - therapy; Staphylococcus aureus; Treatment Outcome; Vancomycin - economics; Vancomycin - therapeutic use
• ISSN: 0149-2918; 1879-114X
• DOI: 10.1016/j.clinthera.2014.06.029

Abstract Purpose Results from studies comparing health care resource use (HCRU), costs of treatment, and cost-effectiveness of linezolid compared with vancomycin therapy in the treatment of hospitalized patients with methicillin-resistant Staphylococcus aureus (MRSA) nosocomial pneumonia are limited in the published literature. We therefore conducted an analysis to compare the HCRU, costs of treatment, and cost-effectiveness of linezolid compared with vancomycin in the treatment of hospitalized patients with MRSA nosocomial pneumonia using data from a Phase IV clinical trial. The economic effect of moderate to severe adverse events (MSAEs) and the development of renal failure were also evaluated. Methods We performed a post hoc analysis of data from a Phase IV, double-blind, randomized, comparator-controlled, multicenter trial that compared linezolid and vancomycin treatment in patients with MRSA nosocomial pneumonia. HCRU and costs were compared based on treatment, development of MSAEs, and development of renal failure using data from the modified intent-to-treat population. Predictors of costs were evaluated using generalized linear models. A piggyback cost-effectiveness analysis was conducted to assess the incremental cost-effectiveness ratio of linezolid versus vancomycin, given the significantly higher clinical success of linezolid compared with vancomycin found in the trial. Findings Overall, HCRU and costs were similar between the linezolid and vancomycin treatment groups; drug costs were significantly higher and dialysis costs significantly lower for linezolid- compared with vancomycin-treated patients. Total treatment costs were approximately $8000 higher ( P = .046) for patients who developed renal failure compared with those who did not. Renal failure occurred more commonly in patients randomized to receive vancomycin (15%) compared with linezolid (4%; P < .001). Region, ventilator-associated pneumonia, clinical failure, and development of renal failure were associated with significantly higher total costs. The point estimate incremental cost-effectiveness ratio for linezolid compared with vancomycin was $16,516 per treatment success, with linezolid dominant in 24% and dominated in