Linezolid for treatment of ventilator-associated pneumonia: a cost-effective alternative to vancomycin.
OBJECTIVE
To determine the incremental cost-effectiveness of linezolid compared with vancomycin for treatment of ventilator-associated pneumonia due to Staphylococcus aureus.


METHODS
Decision model analysis of the cost and efficacy of linezolid vs. vancomycin for treatment of ventilator-associated pneumonia. The primary outcome was the incremental cost-effectiveness of linezolid in terms of cost per added quality-adjusted life-year gained. Other outcomes were the marginal costs per hospital survivor and per year of life saved generated by using linezolid. Model estimates were derived from prospective trials of linezolid for ventilator-associated pneumonia and from other studies describing the costs and outcomes for ventilator-associated pneumonia.


METHODS
Hypothetical cohort of 1,000 patients diagnosed with ventilator-associated pneumonia.


METHODS
In the model, patients received either linezolid or vancomycin.


RESULTS
The incremental cost-effectiveness of linezolid was calculated as the additional quality-adjusted life-years resulting from therapy with linezolid divided by the sum of the incremental costs arising because of use of linezolid (e.g., higher direct costs for linezolid, costs per in-hospital care of survivors, and posthospitalization costs). Despite its higher cost, linezolid was cost-effective for treatment of ventilator-associated pneumonia. The cost per quality-adjusted life-year equals approximately 30,000 dollars. The model was moderately sensitive to the estimated efficacy of linezolid over vancomycin. Nonetheless, even with all inputs simultaneously skewed against, linezolid remains a cost-effective option (cost per quality-adjusted life-year approximately 100,000 dollars). Based on Monte Carlo simulation, the results of our analysis are robust across a range of model inputs and assumptions (95% confidence interval for cost per quality-adjusted life-year ranges from 23,637 dollars to 42,785 dollars).


CONCLUSIONS
Linezolid is a cost-effective alternative to vancomycin for the treatment of ventilator-associated pneumonia.
Shorr
Andrew F
AF
Pulmonary and Critical Care Medicine Service, Walter Reed Army Medical Center, Washington, DC, USA.
Susla
Gregory M
GM
Kollef
Marin H
MH
D000081:Acetamides / Q000191:economics* / Q000627:therapeutic use; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D005260:Female; D017721:Hospital Costs; D006801:Humans; D007362:Intensive Care Units; D000069349:Linezolid; D008297:Male; D023303:Oxazolidinones / Q000191:economics* / Q000627:therapeutic use; D011015:Pneumonia, Aspiration / Q000188:drug therapy* / Q000209:etiology; D011023:Pneumonia, Staphylococcal / Q000188:drug therapy* / Q000209:etiology; D019057:Quality-Adjusted Life Years; D012121:Respiration, Artificial / Q000009:adverse effects* / Q000295:instrumentation; D012128:Respiratory Distress Syndrome / Q000628:therapy; D014481:United States; D014640:Vancomycin / Q000191:economics* / Q000627:therapeutic use; D012122:Ventilators, Mechanical / Q000382:microbiology*
D000081:Acetamides; D023303:Oxazolidinones; D014640:Vancomycin; D000069349:Linezolid