Economic evaluation among Chinese patients with nosocomial pneumonia caused by methicillin-resistant Staphylococcus aureus and treated with linezolid or vancomycin: a secondary, post-hoc analysis based on a Phase 4 clinical trial study.
OBJECTIVE
To assess cost-effectiveness of linezolid vs vancomycin in treating nosocomial pneumonia caused by methicillin-resistant Staphylococcus aureus (MRSA-NP) in China and the impact of renal failure on healthcare resource utilization (HCRU) and costs.


METHODS
Cost-effectiveness analysis was conducted based on data from the ZEPHyR trial, with efficacy measured by treatment success and costs calculated from HCRU. Confidence intervals (CI) for cost, efficacy and incremental cost-effectiveness ratios (ICER) were calculated by non-parametric bootstrap. Chi-square test was used for renal failure rate and t-test for HCRU/cost comparisons. Impact of renal failure was assessed using regression model.


RESULTS
Data from 448 patients (1:1 linezolid:vancomycin) were analyzed. More patients treated with linezolid achieved success (55% [95% CI = 48-62%]) than with vancomycin (45% [38-52%]). Treatment cost were ¥79,551 (95% CI = ¥72,421-¥86,680) for linezolid vs ¥77,587 (¥70,656-¥84,519) for vancomycin in Beijing, ¥90,995 (¥82,598-¥99,393) vs ¥89,448 (¥81,295-¥97,601) in Guangzhou, ¥82,383 (¥74,956-¥89,810) vs ¥80,799 (¥73,545-¥88,054) in Nanjing and ¥59,413 (¥54,366-¥64,460) vs ¥57,804 (¥52,613-¥62,996) in Xi'an. Per successful treatment, the ICER of linezolid over vancomycin were ¥19,719 (-¥143,553 to ¥320,980) (Beijing), ¥15,532 (-¥185,411 to ¥349,693) (Guangzhou), ¥15,904 (-¥161,935 to ¥314,987) (Nanjing) and ¥16,145 (-¥100,738 to ¥234,412) (Xi'an). From simulations, the majority of linezolid cases had greater efficacy and higher costs and more than one third had greater efficacy and lower costs. More vancomycin patients developed renal failure (15% vs 4%, p < 0.001). Patients with renal failure had higher cost (Nanjng: ¥100,449 (SD = ¥65,080) vs ¥74,944 (SD = ¥49,632), p = 0.002).


CONCLUSIONS
Linezolid was more cost-effective than vancomycin in treating MRSA-NP from a Chinese payer's perspective, and associated with less renal failure, HCRU and cost.
a a Pharmerit International , Bethesda , MD , USA.
Yin
Y
Wan
b b Surgical Intensive Care Unit, Department of General Surgery, Jiangsu Province Hospital , Nanjing , PR China.
Qiang
Q
Li
c c Pfizer Investment Co. Ltd , Dongcheng District , Beijing , PR China.
Yixi
Y
Chen
d d Pfizer Inc. , Groton , CT , USA.
Seema
S
Haider
a a Pharmerit International , Bethesda , MD , USA.
Sizhu
S
Liu
a a Pharmerit International , Bethesda , MD , USA.
Xin
X
Gao
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000191:economics* / Q000627:therapeutic use; D002681:China; D015897:Comorbidity; D003362:Cost-Benefit Analysis; D003428:Cross Infection / Q000188:drug therapy*; D004311:Double-Blind Method; D005260:Female; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D000069349:Linezolid / Q000009:adverse effects / Q000191:economics*; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus; D008875:Middle Aged; D017059:Models, Econometric; D018410:Pneumonia, Bacterial / Q000188:drug therapy*; D051437:Renal Insufficiency / Q000139:chemically induced; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D013203:Staphylococcal Infections / Q000188:drug therapy*; D014640:Vancomycin / Q000191:economics* / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D014640:Vancomycin; D000069349:Linezolid
China; Cost-effectiveness analysis; Economics; Methicillin-resistant Staphylococcus aureus; Nosocomial pneumonia; Renal failure