Cost-effectiveness of telavancin versus vancomycin for treatment of complicated skin and skin structure infections.
OBJECTIVE
To determine the cost-effectiveness of telavancin versus vancomycin for the treatment of complicated skin and skin structure infections (cSSSIs).


METHODS
Pharmacoeconomic analysis conducted from the hospital's perspective using data from the Assessment of Telavancin in Complicated Skin and Skin Structure Infections (ATLAS) phase III clinical trial.


METHODS
One hundred twenty-nine hospitals in the United States and internationally.


METHODS
A total of 1044 clinically evaluable patients who were hospitalized with a cSSSI during the ATLAS trial and who received at least one dose of telavancin or vancomycin in the hospital.


RESULTS
Diagnosis-related group-specific hospital bed costs, antibiotic acquisition prices, and cost of vancomycin monitoring were applied to the resource utilization data collected during the ATLAS trial. Infection-related length of stay (LOS(ir)) and hospitalization costs (COST(ir)) were compared between the telavancin (514 patients) and vancomycin (530 patients) groups. Incremental cost-effectiveness ratios (ICERs) were calculated for the total population and a subset of patients infected with methicillin-resistant Staphylococcus aureus (MRSA) by using a 25,000-sample bootstrap analysis. During sensitivity analyses, the daily acquisition price for telavancin was increased from the equivalent to vancomycin ($13.44) to $50, $100, $150, or $200, and the rate of MRSA acquisition was varied between 30% and 75%. The median (interquartile range) LOS(ir) was 8 days (6-12 days) for both telavancin and vancomycin (p=0.742), and median (interquartile range) COST(ir) was $8118 ($6291-11,758) and $8185 ($6474-11,405), respectively (p=0.560). Similar findings were observed for the MRSA subset. Telavancin cost-effectiveness was greater for the MRSA population versus the total population. During bootstrap analyses of the MRSA population, the ICER for telavancin ranged from dominant (-$9560) to $27,889 as acquisition price was increased.


CONCLUSIONS
Telavancin LOS(ir) and total COST(ir) were similar to those of vancomycin for the treatment of cSSSIs. Particularly in those infected with MRSA, telavancin may be more cost-effective than vancomycin over the range of acquisition prices tested.
Laohavaleeson
Somvadee
S
Center for Anti-Infective Research and Development, Hartford Hospital, Hartford, CT 06102, USA.
Barriere
Steven L
SL
Nicolau
David P
DP
Kuti
Joseph L
JL
D000328:Adult; D000368:Aged; D000465:Algorithms; D000617:Aminoglycosides / Q000737:chemistry / Q000191:economics / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents / Q000191:economics / Q000627:therapeutic use; D017326:Clinical Trials, Phase III as Topic; D003362:Cost-Benefit Analysis / Q000379:methods; D016208:Databases, Factual / Q000191:economics / Q000706:statistics & numerical data; D017723:Drug Utilization Review / Q000191:economics / Q000706:statistics & numerical data; D005260:Female; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D000077427:Lipoglycopeptides; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects / Q000302:isolation & purification; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D012867:Skin / Q000187:drug effects* / Q000382:microbiology / Q000473:pathology; D013207:Staphylococcal Skin Infections / Q000188:drug therapy* / Q000382:microbiology; D014640:Vancomycin / Q000191:economics / Q000627:therapeutic use*
D000617:Aminoglycosides; D000900:Anti-Bacterial Agents; D000077427:Lipoglycopeptides; D014640:Vancomycin; C487637:telavancin