Cost-Effectiveness Of Linezolid Vs. Vancomycin In Nosocomial Pneumonia Due To Suspected Methicillin-Resistant Staphylococcus Aureus In France

PIN12 COST-EFFECTIVENESS OF LINEZOLIDVS.VANCOMYCIN IN COMPLICATED SKIN AND SOFT-TISSUE INFECTION DUETO SUSPECTED METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS IN FRANCE De Cock E, Besnier JM, Dupon M, Guery B, Levrat F United BioSource Corporation, Barcelona, Spain, CHRU Bretonneau, Bretonneau, France, Hopital Pellegrin, Bordeaux, France, Hopital Calmette, CHRU Lille, Lille, France, Pfizer, Paris, France OBJECTIVES: Studies have shown similar clinical cure rates and shorter length of stay (LOS) for linezolid compared to vancomycin in patients with complicated skin and soft tissue infections (cSSTI) due to suspected or proven methicillin-resistant Staphylococcus aureus (MRSA). This study examined the clinical and economic consequences of using linezolid vs. vancomycin from the French health system perspective. METHODS: A decisionanalytic model followed an average patient from initiation of empiric treatment until successful 1st-line treatment, death, or 2nd-line treatment failure. Efficacy data were derived from published clinical trials. Resource utilization patterns were collected through structured interviews with 4 French physicians experienced in treating cSSTI. Costs from official price and tariff lists were applied to antibiotics therapy, hospitalisation (by ward type), isolation, tests, adverse events, and post-discharge. Patients could be discharged to oral linezolid. The base case used therapy duration and LOS from the expert panel. Outcomes included total cost per patient, and cost per cure. RESULTS: Average total cost per episode was €7784 for linezolid vs. €8514 for vancomycin (cost savings of €730 mostly due to reduction in hospitalization costs from earlier discharge). Mean LOS after two lines of treatment was 10.7 days for linezolid vs. 13.3 days for vancomycin. An additional 0.5% of patients treated with linezolid (98.5%) vs. vancomycin (98.0%) were cured. Slight increase in effectiveness and reduced cost made linezolid the dominant treatment strategy. One-way sensitivity analysis on selected parameters (50% variation above or below baseline), and a conservative scenario with simultaneous changes in key parameters, did not change the overall conclusions (linezolid remained cost-saving). CONCLUSION: This model showed that linezolid could be cost saving when treating patients with cSSTI due to suspected MRSA, while overall clinical cure was similar. Linezolid could therefore be considered an efficient strategy for treating cSSTI in France.