title: [Pharmacoeconomic assessment of daptomycin as first-line therapy for bacteraemia and complicated skin and skin structure infections caused by gram-positive pathogens in Spain].
abstract: OBJECTIVE
  To assess the efficiency of daptomycin as firstline therapy (D) versus daptomycin as salvage therapy after vancomycin (V→D ) or linezolid (L→D) failure in gram-positive bacteraemia and complicated skin and skin-structure infections (cSSTIs).
  
  
  METHODS
  Cost-effectiveness analysis of 161 bacteraemia and 84 cSSTIs patients comparing the above mentioned therapeutic alternatives was performed using the data from 27 Spanish hospitals involved in the EUCORE study. Direct medical costs were considered. Patients were observed from the first antibiotic dose for infection until either the end of daptomycin therapy or exitus. A multivariate Monte Carlo probabilistic sensitivity analysis was applied for costs (lognormal distribution) and effectiveness (normal distribution).
  
  
  RESULTS
  In terms of effectiveness there were no statistical differences between groups but referring total costs per patient, there were significant differences. Sensitivity analysis confirmed that D dominates over L→D between 44.2%-62.1% of simulations in bacteraemia and between 48.2%-67.5% in cSSTIs. In comparison to V→D, D dominance was detected in 29.2%-33.2% of simulations in bacteraemia and between 48.2%-59.3% in cSSTIs.
  
  
  CONCLUSIONS
  Daptomycin as first-line therapy dominates over daptomycin as salvage therapy after linezolid failure both in bacteraemia and cSSTIs. Comparing daptomycin as first-line therapy with its use after vancomycin failure, in cSSTIs the former is dominant. In bacteremia daptomycin as first line therapy is as effective as daptomycin as salvage therapy after vancomycin failure and implies lower costs.
authors.affiliation: Departamento de Farmacia del Hospital del Mar. Universitat Autònoma de Barcelona, Spain. SGrau@parcdesalutmar.cat
authors.forename: S
authors.initials: S
authors.lastname: Grau
authors.forename: P
authors.initials: P
authors.lastname: Rebollo
authors.forename: J
authors.initials: J
authors.lastname: Cuervo
authors.forename: S
authors.initials: S
authors.lastname: Gil-Parrado
mesh_terms: D000081:Acetamides / Q000191:economics / Q000627:therapeutic use; D000293:Adolescent; 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 / Q000382:microbiology; D003362:Cost-Benefit Analysis; D017576:Daptomycin / Q000191:economics* / Q000627:therapeutic use*; D003627:Data Interpretation, Statistical; D006094:Gram-Positive Bacteria / Q000187:drug effects; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy* / Q000191:economics / Q000382:microbiology; D006761:Hospitals; D006801:Humans; D000069349:Linezolid; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009010:Monte Carlo Method; D023303:Oxazolidinones / Q000191:economics / Q000627:therapeutic use; D016879:Salvage Therapy; D012874:Skin Diseases, Infectious / Q000188:drug therapy* / Q000191:economics / Q000382:microbiology; D013030:Spain; D017211:Treatment Failure; D014640:Vancomycin / Q000191:economics / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D000081:Acetamides; D000900:Anti-Bacterial Agents; D023303:Oxazolidinones; D014640:Vancomycin; D000069349:Linezolid; D017576:Daptomycin