title: Cost-effectiveness analysis of linezolid, daptomycin, and vancomycin in methicillin-resistant Staphylococcus aureus: complicated skin and skin structure infection using Bayesian methods for evidence synthesis.
abstract: BACKGROUND
  Methicillin-resistant Staphylococcus aureus (MRSA) complicated skin and skin structure infection (cSSSI) is a prominent infection encountered in hospital and outpatient settings that is associated with high resource use for the health-care system.
  
  
  OBJECTIVE
  A decision analytic (DA) model was developed to evaluate the cost-effectiveness analysis (CEA) of linezolid, daptomycin, and vancomycin in MRSA cSSSI.
  
  
  METHODS
  Bayesian methods for evidence synthesis were used to generate efficacy and safety parameters for a DA model using published clinical trials. CEA was done from the US health-care perspective. Efficacy was defined as a successfully treated patient at the test of cure without any adverse reaction. Primary outcome was the incremental cost-effectiveness ratio between linezolid and vancomycin, daptomycin and vancomycin, and linezolid and daptomycin in MRSA cSSSI. Univariate and probabilistic sensitivity analyses were performed to test the robustness of the model.
  
  
  RESULTS
  The total direct costs of linezolid, daptomycin, and vancomycin were $18,057, $20,698, and $23,671, respectively. The cost-effectiveness ratios for linezolid, daptomycin, and vancomycin were $37,604, $44,086, and $52,663 per successfully treated patient, respectively. Linezolid and daptomycin were dominant strategies compared to vancomycin. However, linezolid was dominant when compared to daptomycin. The model was sensitive to the duration of daptomycin and linezolid treatment.
  
  
  CONCLUSIONS
  Linezolid and daptomycin are potentially cost-effective based on the assumptions of the DA model; however, linezolid appears to be more cost-effective compared to daptomycin and vancomycin for MRSA cSSSIs.
authors.affiliation: Veterans Affairs San Diego Healthcare System, San Diego, CA 92161, USA. mark.bounthavong@va.gov
authors.forename: Mark
authors.initials: M
authors.lastname: Bounthavong
authors.forename: Amir
authors.initials: A
authors.lastname: Zargarzadeh
authors.forename: Donald I
authors.initials: DI
authors.lastname: Hsu
authors.forename: David J
authors.initials: DJ
authors.lastname: Vanness
mesh_terms: D000081:Acetamides / Q000191:economics* / Q000627:therapeutic use; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000890:Anti-Infective Agents / Q000191:economics* / Q000627:therapeutic use; D001499:Bayes Theorem; D003362:Cost-Benefit Analysis; D017576:Daptomycin / Q000191:economics* / Q000627:therapeutic use; D003661:Decision Support Techniques; D003955:Diagnostic Tests, Routine / Q000191:economics; D016527:Drug Costs; D004359:Drug Therapy, Combination; D006302:Health Services Research; D017721:Hospital Costs; D006801:Humans; D000069349:Linezolid; D055624:Methicillin-Resistant Staphylococcus aureus / Q000472:pathogenicity*; D008875:Middle Aged; D018803:Models, Economic; D010043:Outcome and Process Assessment, Health Care / Q000191:economics*; D023303:Oxazolidinones / Q000191:economics* / Q000627:therapeutic use; D013207:Staphylococcal Skin Infections / Q000175:diagnosis / Q000188:drug therapy / Q000191:economics* / Q000382:microbiology; D016896:Treatment Outcome; D014481:United States; D014640:Vancomycin / Q000191:economics* / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D000081:Acetamides; D000890:Anti-Infective Agents; D023303:Oxazolidinones; D014640:Vancomycin; D000069349:Linezolid; D017576:Daptomycin