title: Health economic evaluation of patients treated for nosocomial pneumonia caused by methicillin-resistant Staphylococcus aureus: secondary analysis of a multicenter randomized clinical trial of vancomycin and linezolid.
abstract: OBJECTIVE
  Results from studies comparing health care resource use (HCRU), costs of treatment, and cost-effectiveness of linezolid compared with vancomycin therapy in the treatment of hospitalized patients with methicillin-resistant Staphylococcus aureus (MRSA) nosocomial pneumonia are limited in the published literature. We therefore conducted an analysis to compare the HCRU, costs of treatment, and cost-effectiveness of linezolid compared with vancomycin in the treatment of hospitalized patients with MRSA nosocomial pneumonia using data from a Phase IV clinical trial. The economic effect of moderate to severe adverse events (MSAEs) and the development of renal failure were also evaluated.
  
  
  METHODS
  We performed a post hoc analysis of data from a Phase IV, double-blind, randomized, comparator-controlled, multicenter trial that compared linezolid and vancomycin treatment in patients with MRSA nosocomial pneumonia. HCRU and costs were compared based on treatment, development of MSAEs, and development of renal failure using data from the modified intent-to-treat population. Predictors of costs were evaluated using generalized linear models. A piggyback cost-effectiveness analysis was conducted to assess the incremental cost-effectiveness ratio of linezolid versus vancomycin, given the significantly higher clinical success of linezolid compared with vancomycin found in the trial.
  
  
  RESULTS
  Overall, HCRU and costs were similar between the linezolid and vancomycin treatment groups; drug costs were significantly higher and dialysis costs significantly lower for linezolid- compared with vancomycin-treated patients. Total treatment costs were approximately $8000 higher (P = .046) for patients who developed renal failure compared with those who did not. Renal failure occurred more commonly in patients randomized to receive vancomycin (15%) compared with linezolid (4%; P < .001). Region, ventilator-associated pneumonia, clinical failure, and development of renal failure were associated with significantly higher total costs. The point estimate incremental cost-effectiveness ratio for linezolid compared with vancomycin was $16,516 per treatment success, with linezolid dominant in 24% and dominated in <2% of bootstrapped samples.
  
  
  CONCLUSIONS
  This phase 4 clinical trial conducted in patients with MRSA-confirmed nosocomial pneumonia reveals that linezolid- compared with vancomycin-treated patients had similar HCRU and total overall costs. Fewer patients developed renal failure during the study while taking linezolid compared with vancomycin, and patients with a documented MSAE or renal failure had increased HCRU and costs. In summary, linezolid may be a cost-effective treatment strategy in MRSA-confirmed nosocomial pneumonia.
authors: Winthrop-University Hospital, Mineola, New York.
authors: Michael S
authors: MS
authors: Niederman
authors: Institut de Cardiologie, Paris, France.
authors: Jean
authors: J
authors: Chastre
authors: Pharmerit International, Bethesda, Maryland.
authors: Caitlyn T
authors: CT
authors: Solem
authors: Pharmerit International, Bethesda, Maryland.
authors: Yin
authors: Y
authors: Wan
authors: Pharmerit International, Bethesda, Maryland. Electronic address: cgao@pharmerit.com.
authors: Xin
authors: X
authors: Gao
authors: Pfizer Inc, Collegeville, Pennsylvania.
authors: Daniela E
authors: DE
authors: Myers
authors: Pfizer Inc, Groton, Connecticut.
authors: Seema
authors: S
authors: Haider
authors: Pfizer Inc, La Jolla, California.
authors: Jim Z
authors: JZ
authors: Li
authors: Pharmerit International, Bethesda, Maryland.
authors: Jennifer M
authors: JM
authors: Stephens
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D003428:Cross Infection / Q000188:drug therapy / Q000191:economics*; D004311:Double-Blind Method; D016527:Drug Costs; D005260:Female; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D000069349:Linezolid / Q000191:economics* / Q000627:therapeutic use; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus; D008875:Middle Aged; D011023:Pneumonia, Staphylococcal / Q000188:drug therapy / Q000191:economics* / Q000382:microbiology; D053717:Pneumonia, Ventilator-Associated / Q000188:drug therapy / Q000191:economics; D006435:Renal Dialysis / Q000191:economics; D051437:Renal Insufficiency / Q000191:economics / Q000628:therapy; D016896:Treatment Outcome; D014640:Vancomycin / Q000191:economics* / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin; D000069349:Linezolid
keywords: MRSA; cost-effectiveness; economics; nosocomial pneumonia; outcomes; renal failure