The Cost-effectiveness of Cefazolin Compared With Antistaphylococcal Penicillins for the Treatment of Methicillin-SensitiveStaphylococcus aureusBacteremia

Abstract

Background Methicillin-sensitive Staphylococcus aureus (MSSA) bacteremia is associated with significant morbidity, mortality, and hospitalization costs. Cefazolin and anti-staphylococcal penicillins (ASPs), such as nafcillin, are the preferred treatments for MSSA bacteremia. The aim of this study was to compare the cost-effectiveness of each approach. Methods We constructed a decision-analytic model comparing the use of cefazolin to ASPs, for the treatment of MSSA bacteremia. Cost-effectiveness was determined by calculating deaths averted and incremental cost-effectiveness ratios (ICER). Uncertainty was addressed by plotting cost-effectiveness planes and acceptability curves for various willingness-to-pay thresholds. Results In the base-case analysis, the cost associated with the cefazolin strategy was $38,863.1 and the associated probability of survival was 0.91. For the ASP strategy the cost was $48,578.8, and the probability of survival was 0.81. The incremental difference in cost between the two strategies was $9,715.7, with hospital length of stay being the main driver of cost, and the incremental difference in effectiveness was 0.10. Overall, cefazolin results in savings of $97,156.8 per death averted (ICER:$- 97,156.8/death averted). In the probabilistic analysis, at a willingness-to-pay of $50,000, cefazolin had a 68% chance of being cost-effective compared to ASPs. In cost-effectiveness acceptability curves, the cefazolin strategy was cost-effective in 73.5%-81.8% of simulations compared to ASP for a willingness-to-pay ranging up to $50,000. Conclusions The use of cefazolin is a cost-effective strategy for the treatment of MSSA bacteremia and, when clinically appropriate, this strategy results in considerable health care cost-savings.

Update on Staphylococcus aureus bacteraemia

“…The case for cefazolin in MS-SAB has been incrementing evidence. In a cost effectiveness analysis Pliakos et al concluded to a cost saving of $97 157 per death averted with cefazolin compared to antistaphylococcal penicillins for MS-SAB [25 ▪ ]. In a post-hoc analysis of a multicentre cohort of methicillin-susceptible Staphylococcus aureus (MSSA) infectious endocarditis, Lecomte et al found similar mortality (24% vs. 29%) but less frequent treatment discontinuation for adverse events – most commonly AKI - with cefazolin than antistaphylococcal penicillins (0% vs. 8%).…”

Economic Evaluation of Nemonoxacin, Moxifloxacin and Levofloxacin in the Treatment of Early Community-Acquired Pneumonia with Possible Pulmonary Tuberculosis

“…Similar economic evaluation research tended to ignore the proportion of patients with CAP who are misdiagnosed with PTB [18,21,23,30,33,34]; therefore, to explore the reliability of the conclusions, and to further verify the value of the differential diagnosis of PTB, a scenario analysis in which PTB was not considered was performed.…”

“…First, the study found that the use of fluoroquinolone antibiotics in the diagnosis and treatment of CAP patients with unclear symptoms increases the risk of delaying the diagnosis of tuberculosis [12]. Second, in the previous articles studying the economics of CAP drugs, the misdiagnosis of tuberculosis patients had not been considered [18,21,23,31,33,34]. This study considered that a certain proportion of patients with CAP were misdiagnosed with tuberculosis and performed a CUA analysis on this basis.…”

“…For example, previous studies have ignored recurrence in patients with successful initial treatment [23]; however, the clinical trial results showed that the effective rate of each drug at Visit 3 was substantially lower than that at Visit 2. Consequently, we believe that in addition to the factors of the change of trial personnel, patients for whom the drug is effective at the initial stage of treatment are likely to relapse in the later stage of treatment or after the end of treatment [34]. Finally, the clinical efficacy data of this study were derived from a multicenter, randomized, double-blind, parallel-controlled randomized controlled trial, which has high reliability and is very suitable for CAP-related evaluations based on the Chinese population.…”

Flucloxacillin and cefazolin for treatment of Staphylococcus aureus bloodstream infection

“…Regarding the question if Cefazolin should be used for central nervous system infections, a recent review concludes Cefazolin being a reasonable option for a variety of CNS infections [ 6 ]. Cefazolin has been attributed less side effects than ASP and seems to result in health care cost savings [ 7 ]. Reviews and meta-analyses have suggested that cefazolin is at least as effective as ASP while possibly being safer and associated with less acute kidney injury [ 8 – 11 ].…”