title: Antibacterial Treatment of Meticillin-Resistant Staphylococcus Aureus Complicated Skin and Soft Tissue Infections: a Cost and Budget Impact Analysis in Greek Hospitals.
abstract: BACKGROUND
  Meticillin-resistant staphylococcus aureus (MRSA) is an important cause of antimicrobial-resistant infections worldwide. Its prevalence remains high in the Greek hospital setting. Complicated skin and soft tissue infections (cSSTIs) due to MRSA are associated with prolonged hospitalization, additional healthcare costs and significant morbidity. The purpose of this study was to conduct a cost analysis and a budget impact analysis relative to different management scenarios for MRSA-cSSTIs from a hospital perspective.
  
  
  METHODS
  Equal efficacy was assumed for the pharmacotherapies under evaluation and resource use was elicited via an expert panel of seven local infectious disease specialists. The model was based on a previously published economic model that was adapted for the Greek hospital setting and included a decision tree for the management of hospitalized patients with MRSA-cSSTIs, which simulated costs and outcomes for the duration of hospitalization according to the therapeutic scenario. Inpatient costs consisted of hospitalization, diagnostic/laboratory testing, physician visits and antibiotic treatment.
  
  
  RESULTS
  Current economic impact of MRSA-cSSTIs for the inpatient setting in Greek hospitals was estimated at €29,196,218. Total per patient cost according to first-line agent was €2,457, €2,762, €2,850, €3,494 and €3,094 and mean length of stay was 9.2, 12.5, 10.3, 13.0 and 14.0 days for linezolid, vancomycin, daptomycin, tigecycline, and teicoplanin, respectively. An estimated 10,287 MRSA-cSSTI patients are treated annually in Greek hospitals. Thus, increasing the use of linezolid by 11% over a 3-year period (current use 19%; 3 year projection 30%), for the management of MRSA-cSSTIs, could result in 3-year savings of €896,065.
  
  
  CONCLUSIONS
  Management of MRSA-cSSTI requires intensive resource use; overall healthcare costs differ according to the chosen first-line treatment. In light of considerable budget constraints, development of hospital strategies which facilitate early discharge, such as the introduction of clinical criteria and guidelines for switching from intravenous to oral MRSA-cSSTI therapy, could result in substantial savings for the Greek hospital budget.
authors.affiliation: Department of Health Economics, National School of Public Health, 196 Alexandras Ave., 115 21, Athens, Greece.
authors.forename: Kostas
authors.initials: K
authors.lastname: Athanasakis
authors.affiliation: Pfizer Hellas, Athens, Greece.
authors.forename: Ioannis
authors.initials: I
authors.lastname: Petrakis
authors.affiliation: Department of Health Economics, National School of Public Health, 196 Alexandras Ave., 115 21, Athens, Greece.
authors.forename: Mark
authors.initials: M
authors.lastname: Ollandezos
authors.affiliation: Pfizer Hellas, Athens, Greece.
authors.forename: Christos
authors.initials: C
authors.lastname: Tsoulas
authors.affiliation: Pharmerit International, Bethesda, MD, USA.
authors.forename: Dipen A
authors.initials: DA
authors.lastname: Patel
authors.affiliation: Department of Health Economics, National School of Public Health, 196 Alexandras Ave., 115 21, Athens, Greece. ekarabli@esdy.edu.gr.
authors.forename: Eleftheria
authors.initials: E
authors.lastname: Karampli
authors.affiliation: Department of Health Economics, National School of Public Health, 196 Alexandras Ave., 115 21, Athens, Greece.
authors.forename: John
authors.initials: J
authors.lastname: Kyriopoulos
keywords: Antibacterial agents; Complicated skin and soft tissue infection; Cost analysis; Daptomycin; Greek hospitals; Linezolid; Meticillin-resistant Staphylococcus aureus; Teicoplanin; Tigecycline; Vancomycin