title: Comparative healthcare-associated costs of methicillin-resistant Staphylococcus aureus bacteraemia-infective endocarditis treated with either daptomycin or vancomycin.
abstract: Complex infection with methicillin-resistant Staphylococcus aureus (MRSA) is associated with high healthcare and societal costs; thus, evaluation of the costs and health benefits of interventions is an important consideration in a modern healthcare system. This study estimated the cost consequences of the use of daptomycin compared with vancomycin for the first-line treatment of patients with proven MRSA-induced bacteraemia-infective endocarditis (SAB-IE) with a vancomycin minimum inhibitory concentration (MIC) >1mg/L in the UK. A decision model was developed to assess total healthcare costs of treatment, including inpatient, outpatient and drug costs. Data were sourced from the literature (treatment efficacy and safety), a physician survey (resource use) and publicly available databases (unit costs). Assuming the same length of stay for daptomycin and vancomycin, the total healthcare costs per patient were £17917 for daptomycin and £17165 for vancomycin. However, extrapolating from published studies and supported by a physician survey, daptomycin was found to require fewer therapeutic switches and a shorter length of stay. When the length of stay was reduced from 42 days to 28 days, daptomycin saved £4037 per person compared with vancomycin. In conclusion, daptomycin is an effective and efficient alternative antibiotic for the treatment of SAB-IE. However, the level of cost saving depends on the extent to which local clinical practice allows early discharge of patients before the end of their antibiotic course when responding to treatment.
authors.affiliation: Evidera, Metro Building, 6th Floor, 1 Butterwick, London W6 8DL, UK. Electronic address: chantelle.browne@evidera.com.
authors.forename: Chantelle
authors.initials: C
authors.lastname: Browne
authors.affiliation: Evidera, Metro Building, 6th Floor, 1 Butterwick, London W6 8DL, UK.
authors.forename: Noemi
authors.initials: N
authors.lastname: Muszbek
authors.affiliation: Evidera, Metro Building, 6th Floor, 1 Butterwick, London W6 8DL, UK.
authors.forename: Ruth
authors.initials: R
authors.lastname: Chapman
authors.affiliation: Evidera, Metro Building, 6th Floor, 1 Butterwick, London W6 8DL, UK.
authors.forename: Kevin
authors.initials: K
authors.lastname: Marsh
authors.affiliation: Aberdeen Royal Infirmary, Foresterhill, Aberdeen AB25 2ZN, UK.
authors.forename: Ian M
authors.initials: IM
authors.lastname: Gould
authors.affiliation: Queen Elizabeth University Hospital, 1345 Govan Road, Glasgow G51 4TF, UK.
authors.forename: R Andrew
authors.initials: RA
authors.lastname: Seaton
authors.affiliation: Former Novartis Pharmaceuticals, UK.
authors.forename: Mike
authors.initials: M
authors.lastname: Allen
mesh_terms: D000900:Anti-Bacterial Agents / Q000191:economics / Q000627:therapeutic use*; D016470:Bacteremia / Q000150:complications / Q000188:drug therapy* / Q000382:microbiology; D003362:Cost-Benefit Analysis; D017576:Daptomycin / Q000191:economics / Q000627:therapeutic use*; D004696:Endocarditis / Q000150:complications / Q000188:drug therapy* / Q000382:microbiology; D017048:Health Care Costs; D006801:Humans; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects* / Q000302:isolation & purification; D008826:Microbial Sensitivity Tests; D006113:United Kingdom; D014640:Vancomycin / Q000191:economics / Q000494:pharmacology / Q000627:therapeutic use*
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin; D017576:Daptomycin
keywords: Cost effectiveness; Daptomycin; Infective endocarditis; Vancomycin