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.
Author(s): Niederman MS(1), Chastre J(2), Solem CT(3), Wan Y(3), Gao X(4), Myers DE(5),
Haider S(6), Li JZ(7), Stephens JM(3).
Affiliation(s): Author information:
(1)Winthrop-University Hospital, Mineola, New York.
(2)Institut de Cardiologie, Paris, France.
(3)Pharmerit International, Bethesda, Maryland.
(4)Pharmerit International, Bethesda, Maryland. Electronic address:
cgao@pharmerit.com.
(5)Pfizer Inc, Collegeville, Pennsylvania.
(6)Pfizer Inc, Groton, Connecticut.
(7)Pfizer Inc, La Jolla, California.
Publication date & source: 2014, Clin Ther. , 36(9):1233-1243
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 <2% of
bootstrapped samples.
IMPLICATIONS: This phase 4 clinical trial conducted in patients with
MRSA-confirmed nosocomial pneumonia reveals that linezolid- compared with
vancomycin-treated patients had similar HCRU and total overall costs. Fewer
patients developed renal failure during the study while taking linezolid compared
with vancomycin, and patients with a documented MSAE or renal failure had
increased HCRU and costs. In summary, linezolid may be a cost-effective treatment
strategy in MRSA-confirmed nosocomial pneumonia.
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