Economic burden of inpatient and outpatient antibiotic treatment for methicillin-resistant Staphylococcus aureus complicated skin and soft-tissue infections: a comparison of linezolid, vancomycin, and daptomycin

Abstract

BackgroundPrevious economic analyses evaluating treatment of methicillin-resistant Staphylococcus aureus (MRSA) complicated skin and soft-tissue infections (cSSTI) failed to include all direct treatment costs such as outpatient parenteral antibiotic therapy (OPAT). Our objective was to develop an economic model from a US payer perspective that includes all direct inpatient and outpatient costs incurred by patients with MRSA cSSTI receiving linezolid, vancomycin, or daptomycin.MethodsA 4-week decision model was developed for this economic analysis. Published literature and database analyses with validation by experts provided clinical, resource use, and cost inputs on data such as efficacy rate, length of stay, adverse events, and OPAT services. Base-case analysis assumed equal efficacy and equal length of stay for treatments. We conducted several sensitivity analyses where assumptions on resource use or efficacy were varied. Costs were reported in year-end 2011 US dollars.ResultsTotal treatment costs in the base-case were lower for linezolid ($10,571) than vancomycin ($11,096), and daptomycin ($13,612). Inpatient treatment costs were $740 more, but outpatient costs, $1,266 less with linezolid than vancomycin therapy due to a switch to oral linezolid when the patient was discharged. Compared with daptomycin, both inpatient and outpatient treatment costs were lower with linezolid by $87 and $2,954 respectively. In sensitivity analyses, linezolid had lower costs compared with vancomycin and daptomycin when using differential length of stay data from a clinical trial, and using success rates from a meta-analysis. In a scenario without peripherally inserted central catheter line costs, linezolid became slightly more expensive than vancomycin (by $285), but remained less costly than daptomycin (by $2,316).ConclusionOutpatient costs of managing MRSA cSSTI may be reduced by 30%–50% with oral linezolid compared with vancomycin or daptomycin. Results from this analysis support potential economic benefit and cost savings of using linezolid versus traditional OPAT when total inpatient and outpatient medical costs are evaluated.

Multidrug-ResistantCorynebacterium striatumAssociated with Increased Use of Parenteral Antimicrobial Drugs

“…Although we documented more adverse events associated with treatment in the C. striatum group than in the coagulase-negative staphylococci group, this difference did not achieve a priori statistical significance, and we did not capture line thrombosis events. Furthermore, parenteral therapy is associated with substantially increased costs, even when comparing an inexpensive parenteral antimicrobial drug (vancomycin) with an expensive oral antimicrobial drug (linezolid) ( 31 ). In addition, parenteral options for C. striatum will be increasingly limited because our group and others have reported clinical failures caused by rapid development of high-level daptomycin resistance ( 14 , 16 , 25 ).…”

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

“…The majority of studies in cSSTIs do report high clinical success and very low mortality rates [ 15 ] which are similar for patients treated with LINE or VANCO [ 20 ], however, second-line efficacy data are lacking. All model assumptions were based on a previously published model [ 19 ] and were considered reasonable by the panel of experts. Moreover, the option of outpatient oral and IV treatment continuation was not taken into consideration as this falls beyond the scope of the study (hospital setting).…”

“…However, this could have a substantial impact on total cost of treatment [ 33 ], especially from an overall healthcare system perspective. Recent evidence shows that the administration of antibacterial treatment administered on an outpatient basis can reduce per patient costs up to 30% [ 19 ].…”

“…A previously published economic model [ 19 ] was adapted for the Greek hospital setting, to examine the healthcare resource use and associated economic impact of different management approaches for MRSA-cSSTIs. The model was developed using Microsoft Excel and Visual Basic, and was based on a decision tree for the management of hospitalized patients with MRSA-cSSTIs (Fig.…”

In Vitro Selection of Single-Stranded DNA Molecular Recognition Elements against S. aureus Alpha Toxin and Sensitive Detection in Human Serum

“…Recent increases in the emergence of methicillin-resistant S. aureus (MRSA) in both health care settings and communities have raised global concerns [ 3 , 4 ]. It was estimated that there were approximately 300,000 patients in the US hospitalized with S. aureus -induced skin/soft tissues infections in 2007, with an average hospital stay of 4.5 days [ 5 , 6 ].…”