Assuntos
Humanos , Acetamidas/uso terapêutico , Anti-Infecciosos/uso terapêutico , Oxazolidinonas/uso terapêutico , Pneumonia Estafilocócica/tratamento farmacológico , Pneumonia Associada à Ventilação Mecânica/tratamento farmacológico , Vancomicina/uso terapêutico , Acetamidas/economia , Anti-Infecciosos/economia , Análise Custo-Benefício , Resistência a Meticilina , Oxazolidinonas/economia , Pneumonia Estafilocócica/microbiologia , Pneumonia Associada à Ventilação Mecânica/microbiologia , Staphylococcus aureus/efeitos dos fármacos , Vancomicina/economiaAssuntos
Acetamidas/uso terapêutico , Anti-Infecciosos/uso terapêutico , Oxazolidinonas/uso terapêutico , Pneumonia Estafilocócica/tratamento farmacológico , Pneumonia Associada à Ventilação Mecânica/tratamento farmacológico , Vancomicina/uso terapêutico , Acetamidas/economia , Anti-Infecciosos/economia , Análise Custo-Benefício , Humanos , Linezolida , Resistência a Meticilina , Oxazolidinonas/economia , Pneumonia Estafilocócica/microbiologia , Pneumonia Associada à Ventilação Mecânica/microbiologia , Staphylococcus aureus/efeitos dos fármacos , Vancomicina/economiaRESUMO
UNLABELLED: Linezolid, an oxazolidinone-class antimicrobial agent, is a new drug; its use has frequently been questioned due to its high price. However, recent trials have demonstrated that the use of linezolid in mechanical ventilation-associated nosocomial pneumonia caused by methicillin-resistant Staphylococcus aureus (VAP-MRSA) may be justified due to its improved efficacy compared to vancomycin. Price and cost have different magnitudes, and clinical efficacy should always be considered in the decision-making process. Our objective was to determine whether linezolid treatment was more cost-effective than vancomycin for treating VAP-MRSA. METHODOLOGY: Elaboration of an economic model from a metanalysis of previous clinical trials comparing both drugs, through a cost-effectiveness analysis. Costs of the treatments were calculated using Brazilian parameters and were compared to the results obtained in the metanalysis. In order to compare the results with real life conditions, costs were calculated for both name brand and for generic vancomycin. RESULTS: The cost (May/2004) per unit (vial, ampoule or bag) was R$ 47.73 for the name-brand vancomycin, R$ 14.45 for generic vancomycin and R$ 214.04 for linezolid. Linezolid's efficacy in VAP-MRSA according to the metanalysis was 62.2% and vancomycin's efficacy was 21.2%. The total cost per cured patient was R$ 13,231.65 for the name-brand vancomycin, R$ 11,277.59 for generic vancomycin and R$ 7,764.72 for linezolid. CONCLUSION: Despite the higher price per unit, linezolid was more cost-effective than vancomycin.
Assuntos
Acetamidas/uso terapêutico , Antibacterianos/uso terapêutico , Infecção Hospitalar/tratamento farmacológico , Oxazolidinonas/uso terapêutico , Pneumonia Estafilocócica/tratamento farmacológico , Vancomicina/uso terapêutico , Acetamidas/economia , Antibacterianos/economia , Análise Custo-Benefício , Infecção Hospitalar/economia , Infecção Hospitalar/etiologia , Custos de Medicamentos , Humanos , Linezolida , Resistência a Meticilina/efeitos dos fármacos , Oxazolidinonas/economia , Pneumonia Estafilocócica/microbiologia , Respiração Artificial/efeitos adversos , Staphylococcus aureus/efeitos dos fármacos , Vancomicina/economiaRESUMO
Linezolid, an oxazolidinone-class antimicrobial agent, is a new drug; its use has frequently been questioned due to its high price. However, recent trials have demonstrated that the use of linezolid in mechanical ventilation-associated nosocomial pneumonia caused by methicillin-resistant Staphylococcus aureus (VAP-MRSA) may be justified due to its improved efficacy compared to vancomycin. Price and cost have different magnitudes, and clinical efficacy should always be considered in the decision-making process. Our objective was to determine whether linezolid treatment was more cost-effective than vancomycin for treating VAP-MRSA. METHODOLOGY: Elaboration of an economic model from a metanalysis of previous clinical trials comparing both drugs, through a cost-effectiveness analysis. Costs of the treatments were calculated using Brazilian parameters and were compared to the results obtained in the metanalysis. In order to compare the results with real life conditions, costs were calculated for both name brand and for generic vancomycin. RESULTS: The cost (May/2004) per unit (vial, ampoule or bag) was R$ 47.73 for the name-brand vancomycin, R$ 14.45 for generic vancomycin and R$ 214.04 for linezolid. Linezolid's efficacy in VAP-MRSA according to the metanalysis was 62.2 percent and vancomycin's efficacy was 21.2 percent. The total cost per cured patient was R$ 13,231.65 for the name-brand vancomycin, R$ 11,277.59 for generic vancomycin and R$ 7,764.72 for linezolid. CONCLUSION: Despite the higher price per unit, linezolid was more cost-effective than vancomycin.
Assuntos
Humanos , Acetamidas/uso terapêutico , Antibacterianos/uso terapêutico , Infecção Hospitalar/tratamento farmacológico , Oxazolidinonas/uso terapêutico , Pneumonia Estafilocócica/tratamento farmacológico , Vancomicina/uso terapêutico , Acetamidas/economia , Antibacterianos/economia , Análise Custo-Benefício , Infecção Hospitalar/economia , Infecção Hospitalar/etiologia , Custos de Medicamentos , Resistência a Meticilina/efeitos dos fármacos , Oxazolidinonas/economia , Pneumonia Estafilocócica/economia , Pneumonia Estafilocócica/etiologia , Respiração Artificial/efeitos adversos , Staphylococcus aureus , Vancomicina/economiaRESUMO
BACKGROUND: Linezolid is a novel oxazolidinone antibiotic that is effective for the treatment of gram-positive bacterial infections. The oral formulation has the potential to reduce length of stay (LOS) when used as a substitute for parenteral glycopeptide antibiotics. In a recent multinational trial comparing linezolid (i.v. followed by oral administration) with teicoplanin (i.v. alone or switched to i.m. administration), linezolid was found to have better efficacy (P = 0.005) and similar safety for treating serious gram-positive infections. OBJECTIVE: The purpose of this study was to compare hospital resource use (primarily LOS) and cost of treatment between linezolid and teicoplanin for hospitalized patients with serious gram-positive infections in South America and Mexico using data from the multinational trial. METHODS: In a multinational, Phase IIIb, open-label, comparator-controlled trial, data were collected from hospitalized patients in centers in 6 South America can countries and Mexico with suspected or confirmed serious gram-positive infections. Patients were randomly assigned to receive i.v. linezolid 600 mg BID (for the entire treatment period [7-28 days] or switched to oral linezolid 600 mg BID) or i.v. teicoplanin (for the entire treatment period or switched to i.m. teicoplanin) dosed per approved prescription information. Data on direct medical resource utilization were collected for each patient, including duration and doses of study medication, location of hospitalization and LOS, comedications, tests and procedures, and outpatient service usage. Unit costs for the medical resources were obtained from secondary sources. RESULTS: A total of 203 patients (97 treated with linezolid and 106 treated with teicoplanin) were enrolled from these 7 countries. The unadjusted results showed that compared with teicoplanin, patients treated with linezolid had a 3.1-day shorter mean i.v. antibiotic treatment duration (P < 0.001), a 2.0- to 2.2-day shorter median and mean LOS (P = 0.03), and a 311 US dollars lower mean total cost of treatment (P = NS). After controlling for age, race, sex, site of infection, inpatient location when the antibiotic treatment started, number of historical and current comorbidities, and whether the patient had a diagnosis of systemic inflammatory response syndrome or sepsis, the multivariate adjusted results were similar to the unadjusted results. The linezolid group had a 1.6-day shorter adjusted LOS or 66% greater odds of early discharge (P = 0.049) and a 335 US dollars lower adjusted mean total cost of treatment (P = NS). CONCLUSION: Linezolid was associated with shorter LOS and duration of IV antibiotic treatment than teicoplanin for serious gram-positive infections in the population studied. Linezolid therapy has the potential to reduce the total cost of treatment.