title: Comparing the cost-effectiveness of linezolid to trimethoprim/sulfamethoxazole plus rifampicin for the treatment of methicillin-resistant Staphylococcus aureus infection: a healthcare system perspective.
abstract: OBJECTIVE
  Few industry-independent studies have been conducted to compare the relative costs and benefits of drugs to treat methicillin-resistant Staphylococcus aureus (MRSA) infection. We performed a stochastic cost-effectiveness analysis comparing two treatment strategies-linezolid versus trimethoprim-sulfamethoxazole plus rifampicin-for the treatment of MRSA infection.
  
  
  METHODS
  We used cost and effectiveness data from a previously conducted clinical trial, complementing with other data from published literature, to compare the two regimens from a healthcare system perspective. Effectiveness was expressed in terms of quality-adjusted life-years (QALYs). Several sensitivity analyses were performed using Monte Carlo simulation, to measure the effect of potential parameter changes on the base-case model results, including potential differences related to type of infection and drug toxicity.
  
  
  RESULTS
  Treatment of MRSA infection with trimethoprim-sulfamethoxazole plus rifampicin and linezolid were found to cost on average €146 and €2536, and lead to a gain of 0.916 and 0.881 QALYs, respectively. Treatment with trimethoprim-sulfamethoxazole plus rifampicin was found to be more cost-effective than linezolid in the base case and remained dominant over linezolid in most alternative scenarios, including different types of MRSA infection and potential disadvantages in terms of toxicity. With a willingness-to-pay threshold of €0, €50 000 and €200 000 per QALY gained, trimethoprim-sulfamethoxazole plus rifampicin was dominant in 100%, 96% and 85% of model iterations. A 95% discount on the current purchasing price of linezolid would be needed when it goes off-patent for it to represent better value for money compared with trimethoprim-sulfamethoxazole plus rifampicin.
  
  
  CONCLUSIONS
  Combined treatment of trimethoprim-sulfamethoxazole plus rifampicin is more cost-effective than linezolid in the treatment of MRSA infection.
authors.affiliation: Infection Control Programme, Geneva University Hospitals and Medical School, Geneva, Switzerland.
authors.forename: E
authors.initials: E
authors.lastname: von Dach
authors.affiliation: Infection Control Programme, Geneva University Hospitals and Medical School, Geneva, Switzerland; London School of Economics, London, UK.
authors.forename: C M
authors.initials: CM
authors.lastname: Morel
authors.affiliation: Incyte Corporation, Epalinges, Switzerland.
authors.forename: A
authors.initials: A
authors.lastname: Murthy
authors.affiliation: Infectious Diseases Unit, Bolzano Central Hospital, Bolzano, Italy; Antimicrobial Stewardship Programme, Annecy-Genevois Hospital Centre, Annecy, France.
authors.forename: L
authors.initials: L
authors.lastname: Pagani
authors.affiliation: Dpto de Laboratorio de Patología Clínica, Facultad de Medicina, Udelar, Uruguay.
authors.forename: M
authors.initials: M
authors.lastname: Macedo-Vinas
authors.affiliation: Division of Infectious Diseases, Geneva University Hospitals and Medical School, Geneva, Switzerland.
authors.forename: F
authors.initials: F
authors.lastname: Olearo
authors.affiliation: Infection Control Programme, Geneva University Hospitals and Medical School, Geneva, Switzerland; Division of Infectious Diseases, Geneva University Hospitals and Medical School, Geneva, Switzerland. Electronic address: stephan.harbarth@hcuge.ch.
authors.forename: S
authors.initials: S
authors.lastname: Harbarth
mesh_terms: D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D006801:Humans; D000069349:Linezolid / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D055624:Methicillin-Resistant Staphylococcus aureus; D012293:Rifampin / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000191:economics / Q000453:epidemiology; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D000069349:Linezolid; D012293:Rifampin
keywords: Cost-effectiveness; Linezolid; Methicillin-resistant Staphylococcus aureus infection; Quality-adjusted life-years; Rifampicin; Trimethoprim-sulfamethoxazole