title: Linezolid Versus Vancomycin in the Empiric Treatment of Nosocomial Pneumonia: A Cost-Utility Analysis Incorporating Results from the ZEPHyR Trial.
abstract: OBJECTIVE
  To examine the cost-effectiveness of vancomycin versus linezolid in the empiric treatment of nosocomial pneumonias incorporating results from a recent prospective, double-blind, multicenter, controlled trial in adults with suspected methicillin-resistant Staphylococcus aureus (MRSA) nosocomial pneumonia.
  
  
  METHODS
  A decision-analytic model examining the cost-effectiveness of linezolid versus vancomycin for the empiric treatment of nosocomial pneumonia was created. Publicly available cost, efficacy, and utility data populated relevant model variables. A probabilistic sensitivity analysis varied parameters in 10,000 Monte-Carlo simulations, and univariate sensitivity analyses assessed the impact of model uncertainties and the robustness of our conclusions.
  
  
  RESULTS
  Results indicated that the cost per quality-adjusted life-year (QALY) increased 6% ($22,594 vs. $23,860) by using linezolid versus vancomycin for nosocomial pneumonia. The incremental cost per QALY gained by using linezolid over vancomycin was $6,089, and the incremental cost per life saved was $68,615 with the use of linezolid. Vancomycin dominated linezolid in the subset of patients with documented MRSA. The incremental cost per QALY gained using linezolid if no mortality benefit exists between agents or a 60-day time horizon was analyzed was $19,608,688 and $443,662, respectively.
  
  
  CONCLUSIONS
  Linezolid may be a cost-effective alternative to vancomycin in the empiric treatment of patients with suspected MRSA nosocomial pneumonia; however, results of our model were highly variable on a number of important variables and assumptions including mortality differences and time frame analyzed.
authors: Department of Pharmacy Services, St. Joseph Mercy Health System, Ann Arbor, MI, USA. Electronic address: cdc008@yahoo.com.
authors: Curtis D
authors: CD
authors: Collins
authors: Department of Pharmacy Services, University of Washington Medical Center, Harborview Medical Center Seattle, Seattle, WA, USA.
authors: Ann K
authors: AK
authors: Schwemm
mesh_terms: D000900:Anti-Bacterial Agents / Q000191:economics* / Q000627:therapeutic use; D003198:Computer Simulation; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D003428:Cross Infection / Q000188:drug therapy* / Q000382:microbiology; D003661:Decision Support Techniques; D016527:Drug Costs; D006801:Humans; D000069349:Linezolid / Q000191:economics* / Q000627:therapeutic use; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects / Q000472:pathogenicity; D018803:Models, Economic; D009010:Monte Carlo Method; D011023:Pneumonia, Staphylococcal / Q000188:drug therapy* / Q000191:economics* / Q000382:microbiology / Q000401:mortality; D011336:Probability; D011446:Prospective Studies; D019057:Quality-Adjusted Life Years; D016896:Treatment Outcome; D035501:Uncertainty; D014640:Vancomycin / Q000191:economics* / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin; D000069349:Linezolid
keywords: linezolid; nosocomial pneumonia; vancomycin