Cost-Effectiveness of daptomycin versus vancomycin and gentamicin for patients with methicillin-resistant Staphylococcus aureus bacteremia and/or endocarditis.
BACKGROUND
Methicillin-resistant Staphylococcus aureus (MRSA) is an increasingly common cause of bacteremia and endocarditis. The cost-effectiveness (CE) of daptomycin was compared with that of vancomycin-gentamicin in patients with MRSA bacteremia with or without endocarditis.


METHODS
With use of data from an open-label, randomized study comparing daptomycin with vancomycin-gentamicin in the aforementioned patient population, 3 cost strata were considered: (1) study drug acquisition (daptomycin, $0.37/mg; vancomycin, $7/g; and gentamicin, $0.12/mg); (2) stratum 1 plus the cost of therapy for treatment failures and adverse events, therapeutic drug monitoring, and preparation and administration of all medications; and (3) stratum 2 plus hospital bed costs. Drug costs were based on mean wholesale price, with other costs based on those for a typical community hospital. Cost-effectiveness ratios were calculated as cost divided by proportion of successes. Sensitivity analyses were performed by varying the study drug cost.


RESULTS
Forty-five (20 successes) and 44 (14 successes) patients received daptomycin and vancomycin-gentamicin, respectively. The respective median cost-effectiveness ratios for daptomycin and vancomycin-gentamicin for each cost stratum were as follows: $4082 (range, $1062-$13,893) and $560 (range, $66-$1649) for stratum 1 (P < .001); $4582 (range, $1109-$21,882) and $1635 (range, $163-$33,444) for stratum 2 (P = .026); $23,639 (range, $6225-$141,132) and $26,073 (range, $5349-$187,287) for stratum 3 (P = .82). Sensitivity analyses indicated that if the cost of vancomycin was $0, strata 3 cost-effectiveness ratios did not differ ($23,639 and $25,668, respectively; P = .85). Similar results between groups were seen among patients with bacteremia.


CONCLUSIONS
When all costs of therapy were considered, the cost-effectiveness of daptomycin and vancomycin-gentamicin was similar, even if the cost of vancomycin was $0.
Bhavnani
S M
SM
Institute for Clinical Pharmacodynamics at Ordway Research Institute, Albany, New York, USA. SBhavnani-icpd@ordwayresearch.org
Prakhya
A
A
Hammel
J P
JP
Ambrose
P G
PG
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000191:economics* / Q000627:therapeutic use*; D016470:Bacteremia / Q000188:drug therapy / Q000191:economics; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D017576:Daptomycin / Q000191:economics* / Q000627:therapeutic use*; D004697:Endocarditis, Bacterial / Q000188:drug therapy / Q000191:economics; D005260:Female; D005839:Gentamicins / Q000191:economics / Q000627:therapeutic use; D006801:Humans; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D013203:Staphylococcal Infections / Q000188:drug therapy* / Q000191:economics; D016896:Treatment Outcome; D014640:Vancomycin / Q000191:economics / Q000627:therapeutic use; D055815:Young Adult
D000900:Anti-Bacterial Agents; D005839:Gentamicins; D014640:Vancomycin; D017576:Daptomycin