Assuntos
Antituberculosos/economia , Custos de Medicamentos , Custos de Cuidados de Saúde , Tuberculose dos Linfonodos/economia , Tuberculose Resistente a Múltiplos Medicamentos/economia , Tuberculose Pleural/economia , Tuberculose Pulmonar/economia , Adulto , Amicacina/economia , Amicacina/uso terapêutico , Ácido Aminossalicílico/economia , Ácido Aminossalicílico/uso terapêutico , Antibacterianos/economia , Antibacterianos/uso terapêutico , Antituberculosos/uso terapêutico , Broncoscopia , Clofazimina/economia , Clofazimina/uso terapêutico , Depressão/complicações , Depressão/diagnóstico , Depressão/tratamento farmacológico , Depressão/psicologia , Emigrantes e Imigrantes , Etambutol/economia , Etambutol/uso terapêutico , Tuberculose Extensivamente Resistente a Medicamentos , Fluoroquinolonas/economia , Fluoroquinolonas/uso terapêutico , Humanos , Índia/etnologia , Isoniazida/economia , Isoniazida/uso terapêutico , Linezolida/economia , Linezolida/uso terapêutico , Masculino , Mediastino , Testes de Sensibilidade Microbiana , Moxifloxacina , Nova Zelândia , Pirazinamida/economia , Pirazinamida/uso terapêutico , Radiografia Torácica , Rifampina/economia , Rifampina/uso terapêutico , Esquizofrenia Paranoide/complicações , Esquizofrenia Paranoide/diagnóstico , Esquizofrenia Paranoide/tratamento farmacológico , Esquizofrenia Paranoide/psicologia , Tuberculose dos Linfonodos/tratamento farmacológico , Tuberculose Resistente a Múltiplos Medicamentos/complicações , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Tuberculose Pleural/tratamento farmacológico , Tuberculose Pulmonar/tratamento farmacológicoRESUMO
OBJECTIVE: To examine the cost-effectiveness of vancomycin versus linezolid in the empiric treatment of nosocomial pneumonias incorporating results from a recent prospective, double-blind, multicenter, controlled trial in adults with suspected methicillin-resistant Staphylococcus aureus (MRSA) nosocomial pneumonia. METHODS: A decision-analytic model examining the cost-effectiveness of linezolid versus vancomycin for the empiric treatment of nosocomial pneumonia was created. Publicly available cost, efficacy, and utility data populated relevant model variables. A probabilistic sensitivity analysis varied parameters in 10,000 Monte-Carlo simulations, and univariate sensitivity analyses assessed the impact of model uncertainties and the robustness of our conclusions. RESULTS: Results indicated that the cost per quality-adjusted life-year (QALY) increased 6% ($22,594 vs. $23,860) by using linezolid versus vancomycin for nosocomial pneumonia. The incremental cost per QALY gained by using linezolid over vancomycin was $6,089, and the incremental cost per life saved was $68,615 with the use of linezolid. Vancomycin dominated linezolid in the subset of patients with documented MRSA. The incremental cost per QALY gained using linezolid if no mortality benefit exists between agents or a 60-day time horizon was analyzed was $19,608,688 and $443,662, respectively. CONCLUSIONS: Linezolid may be a cost-effective alternative to vancomycin in the empiric treatment of patients with suspected MRSA nosocomial pneumonia; however, results of our model were highly variable on a number of important variables and assumptions including mortality differences and time frame analyzed.
Assuntos
Antibacterianos/economia , Infecção Hospitalar/tratamento farmacológico , Custos de Medicamentos , Linezolida/economia , Pneumonia Estafilocócica/tratamento farmacológico , Pneumonia Estafilocócica/economia , Vancomicina/economia , Antibacterianos/uso terapêutico , Simulação por Computador , Redução de Custos , Análise Custo-Benefício , Infecção Hospitalar/microbiologia , Técnicas de Apoio para a Decisão , Humanos , Linezolida/uso terapêutico , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Staphylococcus aureus Resistente à Meticilina/patogenicidade , Modelos Econômicos , Método de Monte Carlo , Pneumonia Estafilocócica/microbiologia , Pneumonia Estafilocócica/mortalidade , Probabilidade , Estudos Prospectivos , Anos de Vida Ajustados por Qualidade de Vida , Resultado do Tratamento , Incerteza , Vancomicina/uso terapêuticoRESUMO
Vancomycin-resistant enterococci (VRE) are a growing health problem, and uncertainties exist regarding the optimal therapy for bloodstream infection due to VRE. We conducted systematic comparative evaluations of the impact of different antimicrobial therapies on the outcomes of patients with bloodstream infections due to VRE. A retrospective study from January 2008 to October 2010 was conducted at Detroit Medical Center. Unique patients with blood cultures due to VRE were included and reviewed. Three major therapeutic classes were analyzed: daptomycin, linezolid, and ß-lactams. Three multivariate models were conducted for each outcome, matching for a propensity score predicting the likelihood of receipt of one of the therapeutic classes. A total of 225 cases of bacteremia due to VRE were included, including 86 (38.2%) cases of VR Enterococcus faecalis and 139 (61.8%) of VR Enterococcus faecium. Bacteremia due to VR E. faecalis was more frequent among subjects treated with ß-lactams than among those treated with daptomycin or linezolid. The median dose of daptomycin was 6 mg/kg of body weight (range, 6 to 12 mg/kg). After controlling for propensity score and bacteremia due to VR E. faecalis, differences in mortality were nonsignificant among the treatment groups. Therapy with daptomycin was associated with higher median variable direct cost per day than that for linezolid. This large study revealed the three therapeutic classes (daptomycin, linezolid, and ß-lactams) are similarly efficacious in the treatment of bacteremia due to susceptible strains of VRE.