Antibacterial Treatment of Meticillin-Resistant Staphylococcus Aureus Complicated Skin and Soft Tissue Infections: a Cost and Budget Impact Analysis in Greek Hospitals

Abstract

IntroductionMeticillin-resistant staphylococcus aureus (MRSA) is an important cause of antimicrobial-resistant infections worldwide. Its prevalence remains high in the Greek hospital setting. Complicated skin and soft tissue infections (cSSTIs) due to MRSA are associated with prolonged hospitalization, additional healthcare costs and significant morbidity. The purpose of this study was to conduct a cost analysis and a budget impact analysis relative to different management scenarios for MRSA-cSSTIs from a hospital perspective.MethodsEqual efficacy was assumed for the pharmacotherapies under evaluation and resource use was elicited via an expert panel of seven local infectious disease specialists. The model was based on a previously published economic model that was adapted for the Greek hospital setting and included a decision tree for the management of hospitalized patients with MRSA-cSSTIs, which simulated costs and outcomes for the duration of hospitalization according to the therapeutic scenario. Inpatient costs consisted of hospitalization, diagnostic/laboratory testing, physician visits and antibiotic treatment.ResultsCurrent economic impact of MRSA-cSSTIs for the inpatient setting in Greek hospitals was estimated at €29,196,218. Total per patient cost according to first-line agent was €2,457, €2,762, €2,850, €3,494 and €3,094 and mean length of stay was 9.2, 12.5, 10.3, 13.0 and 14.0 days for linezolid, vancomycin, daptomycin, tigecycline, and teicoplanin, respectively. An estimated 10,287 MRSA-cSSTI patients are treated annually in Greek hospitals. Thus, increasing the use of linezolid by 11% over a 3-year period (current use 19%; 3 year projection 30%), for the management of MRSA-cSSTIs, could result in 3-year savings of €896,065.ConclusionManagement of MRSA-cSSTI requires intensive resource use; overall healthcare costs differ according to the chosen first-line treatment. In light of considerable budget constraints, development of hospital strategies which facilitate early discharge, such as the introduction of clinical criteria and guidelines for switching from intravenous to oral MRSA-cSSTI therapy, could result in substantial savings for the Greek hospital budget.Electronic supplementary materialThe online version of this article (doi:10.1007/s40121-014-0044-8) contains supplementary material, which is available to authorized users.

Six-Year Retrospective Review of Hospital Data on Antimicrobial Resistance Profile of Staphylococcus aureus Isolated from Skin Infections from a Single Institution in Greece

“…Global MRSA rates vary from 26–30% in Africa, Europe and the Middle East to 50% in North America and 55% in Latin America, significantly decreasing overall between 2004 and 2014 [ 7 ]. In Greece, where antimicrobial drug resistance remains high, MRSA prevalence reaches 40%, which is among the highest in Europe [ 8 , 9 , 10 , 11 , 12 ]. However, in a multicenter European study investigating MRSA infections among patients in the emergency department, lower MRSA rates (27%) from Greece were reported, compatible with our results [ 13 ].…”

Budget impact analysis of medicines: updated systematic review and implications

“…Perspective: 82 studies (89%) [12][13][14][15][16][17][19][20][21][22][23][24][70][71][72]77,78,[80][81][82][83][84][85][87][88][89][90][91][92][93][95][96][97][98][99][100][101][102][103] that performed BIA were focused on the budget holder. In all, the perspective of the 92 studies was broken down as follows: the public health system (59%), health insurance companies (24%), paying parties (10%), hospitals (5%), and society (2%).…”

“…Direct costs: 62 studies (67%)[12][13][14][15][16][17][18][19][20]22,24,25,[29][30][31]35,36,38,39,[41][42][43][44][45]47,48,50,[52][53][54][55][56][57][58][59][60][61][64][65][66][67]69,71,72,75,76,79,[81][82][83][84]89,[91]…”

Profile of tedizolid phosphate and its potential in the treatment of acute bacterial skin and skin structure infections

“…However, there are several pharmacoeconomic evaluations of linezolid to vancomycin and/or daptomycin. 30 – 37 These studies consistently conclude that linezolid, especially use of the oral formulation, is associated with significant cost savings. While some of these studies suffer from significant design flaws and/or potential conflicts of interest, the cost savings associated with a decreased length of stay and the lack of outpatient parenteral therapy (and the health care personnel required to deliver it) make sense intuitively.…”