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Buendía JA, Patiño DG, Zuluaga Salazar AF. Cost-effectiveness of linezolid to ventilator-associated pneumonia in Colombia. BMC Infect Dis 2024; 24:98. [PMID: 38238670 PMCID: PMC10795396 DOI: 10.1186/s12879-023-08961-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 12/28/2023] [Indexed: 01/22/2024] Open
Abstract
INTRODUCTION Ventilator-associated pneumonia (VAP) is a prominent cause of morbidity and mortality in intensive care unit (ICU) patients. Due to the increase in Methicillin resistant Staphylococcus aureus infection, it is important to consider other more effective and safer alternatives compared to vancomycin. This motivates evaluating whether the use of an apparently more expensive drug such as linezolid can be cost-effective in Colombia. METHODS A decision tree was used to simulate the results in terms of the cost and proportion of cured patients. In the simulation, patients can receive antibiotic treatment with linezolid (LZD 600 mg IV/12 h) or vancomycin (VCM 15 mg/kg iv/12 h) for 7 days, patients they can experience events adverse (renal failure and thrombocytopenia). The model was analyzed probabilistically, and a value of information analysis was conducted to inform the value of conducting further research to reduce current uncertainties in the evidence base. Cost-effectiveness was evaluated at a willingness-to-pay (WTP) value of US$5180. RESULTS The mean incremental cost of LZD versus VCM is US$-517. This suggests that LZD is less costly. The proportion of patients cured when treated with LZD compared with VCM is 53 vs. 43%, respectively. The mean incremental benefit of LZD versus VCM is 10 This position of absolute dominance (LZD has lower costs and higher proportion of clinical cure than no supplementation) is unnecessary to estimate the incremental cost-effectiveness ratio. There is uncertainty with a 0.999 probability that LZD is more cost-effective than VCM. Our base-case results were robust to variations in all assumptions and parameters. CONCLUSION LNZ is a cost-effective strategy for patients, ≥ 18 years of age, with VAP in Colombia- Our study provides evidence that can be used by decision-makers to improve clinical practice guidelines.
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Affiliation(s)
- Jefferson Antonio Buendía
- Department of Pharmacology and Toxicology, Facultad de Medicina, Universidad de Antioquia, Medellin, Colombia.
- Research Group in Pharmacology and Toxicology, University of Antioquia, Medellín, Colombia.
| | - Diana Guerrero Patiño
- Research Group in Pharmacology and Toxicology, University of Antioquia, Medellín, Colombia
| | - Andrés Felipe Zuluaga Salazar
- Research Group in Pharmacology and Toxicology, University of Antioquia, Medellín, Colombia
- Laboratorio Integrado de Medicina Especializada (LIME), Facultad de Medicina, IPS Universitaria, Universidad de Antioquia, Antioquia, Colombia
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Wagner AP, Enne VI, Livermore DM, Craig JV, Turner DA. Review of health economic models exploring and evaluating treatment and management of hospital-acquired pneumonia and ventilator-associated pneumonia. J Hosp Infect 2020; 106:745-756. [PMID: 32971194 DOI: 10.1016/j.jhin.2020.09.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 09/08/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND Hospital-acquired pneumonia (HAP) is pneumonia that occurs ≥48 h after hospital admission; it is the most common hospital-acquired infection contributing to death. Ventilator-associated pneumonia (VAP) arises ≥48-72 h after intubation. Opinions differ on whether VAP is a subset of HAP; the same pathogens predominate in both. Compared with VAP-free controls, patients developing VAP are twice as likely to die and have significantly longer stays in intensive care units. Guidelines recommend that microbiological cultures should guide antibiotic treatment, but these lack sensitivity and take 48-72 h to process, meaning that initial therapy must be empiric, generally with broad-spectrum agents. Given increasing pressure to improve both antibiotic stewardship and patient outcomes, the National Institute for Health and Care Excellence and the Infectious Diseases Society of America recommend research into rapid molecular diagnostic tests to identify causative organisms and their antibiotic resistances. Ideally, these would supersede culture, being quicker and more sensitive. In the UK, the INHALE research programme, funded by the National Institute for Health Research, is exploring rapid molecular diagnostics to inform treatment of HAP/VAP and, given resource implications, incorporates a health economic component. AIM To identify previous economic modelling of HAP/VAP costs to inform this component. METHODS Literature review of HAP/VAP studies with economic modelling identified from three databases. FINDINGS Twenty studies were identified. Only one study specifically evaluated strategies to improve diagnosis; the remaining 19 studies omitted this important aspect. CONCLUSION HAP/VAP modelling would be improved by better awareness of long-term outcomes and treatment complexity. To the authors' knowledge, no similar literature reviews of economic modelling for HAP/VAP have been published.
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Affiliation(s)
- A P Wagner
- Norwich Medical School, University of East Anglia, Norwich, UK; National Institute for Health Research Applied Research Collaboration East of England, Cambridge, UK.
| | - V I Enne
- University College London, London, UK
| | - D M Livermore
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - J V Craig
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - D A Turner
- Norwich Medical School, University of East Anglia, Norwich, UK
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Maclayton DO, Hall RG. Infectious Diseases: Pharmacologic Treatment Options for Nosocomial Pneumonia Involving Methicillin-Resistant Staphylococcus aureus. Ann Pharmacother 2016; 41:235-44. [PMID: 17299012 DOI: 10.1345/aph.1h414] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Objective: To discuss current and potential treatment options for nosocomial pneumonia due to methicillin-resistant Staphylococcus aureus (MRSA). Data Sources: A MEDLINE search (1966–January 2007) was conducted to identify English-language literature on pharmacotherapy of nosocomial pneumonia and the bibliographies of pertinent articles. Programs and abstracts from infectious disease meetings were also searched. Search terms included MRSA, nosocomial pneumonia, pulmonary infections, vancomycin, quinupristin/dalfopristin, linezolid, daptomycin, tigecycline, dalbavancin, oritavancin, and ceftobiprole. Data Selection and Data Extraction: All articles were critically evaluated and all pertinent information was included in this review. Data Synthesis: Vancomycin has been the drug of choice for MRSA infections for many years. Recent data suggest that linezolid may be superior to vancomycin in the treatment of MRSA nosocomial pneumonia. However, there are limitations to the available data. Therefore, prospective, randomized studies are needed before linezolid is recommended as the preferred first-line therapy. Other approved agents for nosocomial MRSA infections, such as quinupristin/dalfopristin and daptomycin, should not be used in the treatment of MRSA pneumonia, as they were inferior in clinical trials. Tigecycline has excellent activity against MRSA in vitro, but should not be routinely used for the treatment of MRSA pneumonia, as clinical data are lacking. In a Phase III clinical trial, an anti-MRSA cephalosporin, ceftobiprole, is being evaluated for effectiveness against nosocomial pneumonia. Investigational glycopeptides may eventually have a role in the treatment of nosocomial pneumonia, but data are currently lacking. Conclusions: Vancomycin is still the drug of choice for treatment of MRSA pneumonia, and linezolid should be used as an alternative agent. Linezolid should carry strong consideration for patients with vancomycin-induced nephrotoxicity or a documented lack of response to vancomycin. Tigecycline and investigational agents with activity against MRSA may be future options for nosocomial pneumonia due to MRSA.
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Affiliation(s)
- Darego O Maclayton
- Texas Southern University College of Pharmacy & Health Sciences, Michael E DeBakey Veterans Affairs Medical Center, Houston, TX 77004, USA.
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4
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Verhoef TI, Morris S. Cost-effectiveness and pricing of antibacterial drugs. Chem Biol Drug Des 2015; 85:4-13. [PMID: 25521641 PMCID: PMC4328457 DOI: 10.1111/cbdd.12417] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 07/17/2014] [Accepted: 08/13/2014] [Indexed: 01/28/2023]
Abstract
Growing resistance to antibacterial agents has increased the need for the development of new drugs to treat bacterial infections. Given increasing pressure on limited health budgets, it is important to study the cost-effectiveness of these drugs, as well as their safety and efficacy, to find out whether or not they provide value for money and should be reimbursed. In this article, we systematically reviewed 38 cost-effectiveness analyses of new antibacterial agents. Most studies showed the new antibacterial drugs were cost-effective compared to older generation drugs. Drug pricing is a complicated process, involving different stakeholders, and has a large influence on cost-effectiveness. Value-based pricing is a method to determine the price of a drug at which it can be cost-effective. It is currently unclear what the influence of value-based pricing will be on the prices of new antibacterial agents, but an important factor will be the definition of ‘value’, which as well as the impact of the drug on patient health might also include other factors such as wider social impact and the health impact of disease.
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Affiliation(s)
- Talitha I Verhoef
- Department of Applied Health Research, University College London, Gower Street, London, WC1E 6BT, UK
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5
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Collins CD, Schwemm AK. Linezolid Versus Vancomycin in the Empiric Treatment of Nosocomial Pneumonia: A Cost-Utility Analysis Incorporating Results from the ZEPHyR Trial. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2015; 18:614-621. [PMID: 26297089 DOI: 10.1016/j.jval.2015.04.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 04/07/2015] [Accepted: 04/24/2015] [Indexed: 06/04/2023]
Abstract
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.
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Affiliation(s)
- Curtis D Collins
- Department of Pharmacy Services, St. Joseph Mercy Health System, Ann Arbor, MI, USA.
| | - Ann K Schwemm
- Department of Pharmacy Services, University of Washington Medical Center, Harborview Medical Center Seattle, Seattle, WA, USA
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Chastre J, Blasi F, Masterton RG, Rello J, Torres A, Welte T. European perspective and update on the management of nosocomial pneumonia due to methicillin-resistant Staphylococcus aureus after more than 10 years of experience with linezolid. Clin Microbiol Infect 2014; 20 Suppl 4:19-36. [PMID: 24580739 DOI: 10.1111/1469-0691.12450] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) is an important cause of antimicrobial-resistant hospital-acquired infections worldwide and remains a public health priority in Europe. Nosocomial pneumonia (NP) involving MRSA often affects patients in intensive care units with substantial morbidity, mortality and associated costs. A guideline-based approach to empirical treatment with an antibacterial agent active against MRSA can improve the outcome of patients with MRSA NP, including those with ventilator-associated pneumonia. New methods may allow more rapid or sensitive diagnosis of NP or microbiological confirmation in patients with MRSA NP, allowing early de-escalation of treatment once the pathogen is known. In Europe, available antibacterial agents for the treatment of MRSA NP include the glycopeptides (vancomycin and teicoplanin) and linezolid (available as an intravenous or oral treatment). Vancomycin has remained a standard of care in many European hospitals; however, there is evidence that it may be a suboptimal therapeutic option in critically ill patients with NP because of concerns about its limited intrapulmonary penetration, increased nephrotoxicity with higher doses, as well as the emergence of resistant strains that may result in increased clinical failure. Linezolid has demonstrated high penetration into the epithelial lining fluid of patients with ventilator-associated pneumonia and shown statistically superior clinical efficacy versus vancomycin in the treatment of MRSA NP in a phase IV, randomized, controlled study. This review focuses on the disease burden and clinical management of MRSA NP, and the use of linezolid after more than 10 years of clinical experience.
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Affiliation(s)
- J Chastre
- Service de Réanimation Médicale, Institut de Cardiologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
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Cost-Effectiveness of Linezolid versus Vancomycin among Patients with Methicillin-Resistant Staphylococcus aureus Confirmed Nosocomial Pneumonia in China. Value Health Reg Issues 2014; 3:94-100. [PMID: 29702944 DOI: 10.1016/j.vhri.2014.03.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To estimate the cost-effectiveness of intravenous linezolid as a first-line agent against intravenous vancomycin in treating methicillin-resistant Staphylococcus aureus-confirmed nosocomial pneumonia in four Chinese cities. METHODS A decision-analytic model of 4-week time horizon was used to conduct cost-effectiveness analyses from the payer's perspective. Clinical outcomes and resource use data were derived from a head-to-head trial, supplemented with local cost estimates based on hospital data via an expert panel. A series of scenario analyses were conducted to evaluate the impact of uncertainty around model inputs. All results were reported in 2012 Chinese Renminbi. RESULTS The predicted probability of overall treatment success was 0.629 and 0.602 for linezolid and vancomycin, respectively. Total inpatient costs varied across the four cities, ranging from ¥58,835 to ¥86,894 for linezolid and ¥58,390 to ¥87,033 for vancomycin, respectively. Linezolid was demonstrated to be a dominant treatment strategy in Guangzhou. In Beijing, Nanjing, and Xi'an, incremental cost-effectiveness ratios in terms of additional successfully treated patient were ¥1,861, ¥163, and ¥16,509, respectively. Dominance by linezolid was observed in some scenario analyses with parameters such as treatment duration, inclusion of cost of managing adverse events, and drug acquisition costs being the main drivers of cost-effectiveness results. CONCLUSIONS Despite linezolid's higher drug acquisition cost, its superior clinical efficacy renders it a likely cost-effective alternative for the treatment of methicillin-resistant Staphylococcus aureus-confirmed nosocomial pneumonia as compared with branded vancomycin from the payer perspectives of Beijing, Guangzhou, Nanjing, and Xi'an.
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8
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Evaluation of the Relationship Between Elevated Vancomycin Trough Concentrations and Increased Efficacy and/or Toxicity. J Burn Care Res 2013; 34:e1-9. [DOI: 10.1097/bcr.0b013e3182676ee8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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9
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Vanni T, Luz PM, Ribeiro RA, Novaes HMD, Polanczyk CA. [Economic evaluation in health: applications in infectious diseases]. CAD SAUDE PUBLICA 2010; 25:2543-52. [PMID: 20191146 DOI: 10.1590/s0102-311x2009001200002] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2009] [Accepted: 10/27/2009] [Indexed: 01/09/2023] Open
Abstract
The rise in healthcare expenditures due to the incorporation of new diagnostic and therapeutic technologies and increasing life expectancy is a major concern, particularly in developing countries. The role of economic evaluation in health is to optimize the benefits of available resources. This article aims to allow readers to identify the basic characteristics and types of economic evaluation in health and understand its methods, with an emphasis on infectious diseases. We thus review the following concepts: study perspective, analytic scope, costs, and discount rate. We also focus on characteristics of cost-minimization, cost-effectiveness, cost-utility, and cost-benefit analyses, with examples. The article describes the most popular study designs for economic evaluation, discusses different models, and examines the importance of sensitivity analysis. Our final comments address the importance of adopting economic evaluations in health in Brazil.
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Affiliation(s)
- Tazio Vanni
- Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, U.K
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10
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Abstract
Many emerging pathogens present in the skin and are of interest to dermatologists. Recent epidemics of measles, avian flu, and SARS demonstrated how an organism can rapidly spread worldwide because of airline travel. Travelers are often contagious before they are aware that they have the disease, contributing to the spread. This article reviews bacterial, mycobacterial, fungal, and viral pathogens important to dermatologists.
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Affiliation(s)
- Dirk M Elston
- Department of Dermatology, Geisinger Medical Center, 100 North Academy Avenue, Danville, PA 17821, USA.
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11
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Abstract
BACKGROUND New antibiotics efficacious in infections caused by resistant Gram-positive microorganisms and with acceptable costs for national health systems per unit of effectiveness are needed. OBJECTIVE This paper aimed to summarize all available evidence regarding the pharmacoeconomics of linezolid. METHODS A systematic review of pharmacoeconomic analyses through a non-restricted literature search was conducted. RESULTS/CONCLUSIONS Linezolid, as compared to vancomycin and teicoplanin, results in a reduction of the necessary resources for the treatment of infections caused by Gram-positive microorganisms. These benefits are attributable to clinical outcomes and to savings associated with the ease of switching from intravenous to oral administration, the shorter duration of intravenous therapy and earlier hospital discharge. Likewise, linezolid, compared to vancomycin and teicoplanin, is a cost-effective treatment.
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Affiliation(s)
- Santiago Grau
- Hospital del Mar, Pharmacy Department, Passeig Marítim, 25-29, 08003 Barcelona, Spain.
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12
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Estes L, Orenstein R. Cost-effectiveness analysis of linezolid compared with vancomycin for the treatment of nosocomial pneumonia caused by methicillin-resistant Staphylococcus aureus. Clin Ther 2007; 29:381-3; author reply 383-4. [PMID: 17472831 DOI: 10.1016/j.clinthera.2007.02.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Salerno D, Vahid B, Marik PE. Methicillin-resistant Staphylococcus aureus pneumonia after thoracic surgery: successful treatment with linezolid after failed vancomycin therapy. Ann Thorac Surg 2007; 83:1888-91. [PMID: 17462428 DOI: 10.1016/j.athoracsur.2006.11.068] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2006] [Revised: 11/20/2006] [Accepted: 11/20/2006] [Indexed: 11/15/2022]
Abstract
We describe 3 patients with methicillin-resistant Staphylococcus aureus, hospital-acquired pneumonia who demonstrated a microbiological and clinical failure with vancomycin despite adequate trough levels. All 3 patients were cured with linezolid.
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Affiliation(s)
- Daniel Salerno
- Department of Pulmonary and Critical Care Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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14
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Pieracci FM, Barie PS. Article Commentary: Strategies in the Prevention and Management of Ventilator-Associated Pneumonia. Am Surg 2007. [DOI: 10.1177/000313480707300501] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Ventilator-associated pneumonia (VAP) is a leading cause of morbidity and mortality in the intensive care unit. Prevention of VAP is possible through the use of several evidence-based strategies intended to minimize intubation, the duration of mechanical ventilation, and the risk of aspiration of oropharyngeal pathogens. Current data favor the quantitative analysis of lower respiratory tract cultures for the diagnosis of VAP, accompanied by the initiation of broad-spectrum empiric antimicrobial therapy based on patient risk factors for infection with multi-drug-resistant pathogens and data from unit-specific antibiograms. Eventual choice of antibiotic and duration of therapy are selected based on culture results and patient stability, with an emphasis on minimization of unnecessary antibiotic use.
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Affiliation(s)
- Fredric M. Pieracci
- Departments of Surgery and Public Health, Weill Medical College, Cornell University, New York, New York
| | - Philip S. Barie
- Departments of Surgery and Public Health, Weill Medical College, Cornell University, New York, New York
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15
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Methicillin-Sensitive and Methicillin-Resistant Staphylococcus aureus: Management Principles and Selection of Antibiotic Therapy. Dermatol Clin 2007; 25:157-64, vi. [DOI: 10.1016/j.det.2007.01.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Shorr AF. Epidemiology and economic impact of meticillin-resistant Staphylococcus aureus: review and analysis of the literature. PHARMACOECONOMICS 2007; 25:751-68. [PMID: 17803334 DOI: 10.2165/00019053-200725090-00004] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
In the past 2 decades, meticillin-resistant Staphylococcus aureus (MRSA) has become an increasingly prevalent problem in healthcare, both in acute care institutions and in the community. MRSA is associated with worse outcomes and higher costs for care than meticillin sensitive S. aureus (MSSA). MRSA is a particular problem in several conditions, including hospital-acquired pneumonia (including ventilator-associated pneumonia), skin and soft tissue infections, and diabetic foot infections. Hospitalisation costs associated with MRSA infection are substantially greater than those associated with MSSA infection, and MRSA has wider economic effects that involve indirect costs to the patient and to society. In several countries, infection control programmes have shown potential economic benefits, as savings accruing from strict and effective control have been shown to outweigh the cost of policy implementation. Standard therapy is based on glycopeptide treatment, usually with vancomycin, although resistance to this agent has emerged. Alternative available treatments for MRSA include teicoplanin, tigecycline, daptomycin, quinupristin-dalfopristin and the oxazolidinone, linezolid, which has a higher acquisition cost than vancomycin but is available as intravenous and oral formulations. Despite some limitations of analyses to date, linezolid has been shown to be cost effective in the treatment of MRSA and appears to be related, in part, to the drug's potential for facilitating earlier discharge from hospital. Current opinion favours rational prescribing to maximise therapeutic benefit and minimise the risk of further antibacterial resistance.
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Affiliation(s)
- Andrew F Shorr
- Pulmonary and Critical Care Medicine, Washington Hospital Center, Washington, DC 20010, USA.
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17
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Anstead GM, Quinones-Nazario G, Lewis JS. Treatment of infections caused by resistant Staphylococcus aureus. Methods Mol Biol 2007; 391:227-58. [PMID: 18025681 DOI: 10.1007/978-1-59745-468-1_17] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
We review data on the treatment of infections caused by drug-resistant Staphylococcus aureus, particularly methicillin-resistant S. aureus (MRSA). In this review, we cover findings reported in the English language medical literature up to February 2006. Despite the emergence of resistant and multidrug resistant S. aureus, five effective drugs for which little resistance has been observed are in clinical use: vancomycin, quinupristin-dalfopristin, linezolid, tigecycline, and daptomycin. However, vancomycin is less effective for infections with MRSA isolates that have a high minimum inhibitory concentration in the susceptible range. Linezolid looks promising in the treatment of MRSA pneumonia and skin and soft-tissue infections (SSTIs). Daptomycin displays rapid bactericidal activity in vitro, and it has been shown to be noninferior to comparator agents in the treatment of SSTIs and bacteremia. Tigecycline was also noninferior to comparator drugs in the treatment of SSTIs. Clindamycin, trimethoprim-sulfamethoxazole, doxycycline, and minocycline are oral antistaphylococcal agents that may have utility in the treatment of SSTIs and osteomyelitis, but the clinical data for their efficacy is limited. There are four drugs with broad-spectrum activity against Gram-positive organisms at an advanced stage of clinical testing: ceptobiprole and three new glycopeptides with potent bactericidal activity, oritavancin, dalbavancin, and telavancin. Thus, there are currently many effective drugs to treat resistant S. aureus infections and many promising agents in the pipeline. Nevertheless, S. aureus remains a formidable adversary against which there are frequent treatment failures. The next goals are to determine the most appropriate indications and cost-effectiveness of each of these drugs in the treatment strategy against S. aureus.
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Affiliation(s)
- Gregory M Anstead
- Division of Infectious Diseases, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
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18
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Elston DM. Community-acquired methicillin-resistant Staphylococcus aureus. J Am Acad Dermatol 2007; 56:1-16; quiz 17-20. [PMID: 17190619 DOI: 10.1016/j.jaad.2006.04.018] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2005] [Revised: 04/05/2006] [Accepted: 04/11/2006] [Indexed: 12/11/2022]
Abstract
UNLABELLED Published data confirm that community-acquired methicillin-resistant Staphylococcus aureus (MRSA) infections are increasing in incidence in both urban and rural settings. The statistical risk is higher for athletes, military personnel, prison inmates, intravenous drug abusers, the homeless, children in daycare, and certain Native American groups, but the infections are by no means restricted to these populations. Roughly 85% of the infections involve the skin and subcutaneous tissue, with the most common presentations being an abscess or folliculitis. The typical associated gene cassette is quite small and codes only for methicillin resistance. Abscesses generally respond to drainage. LEARNING OBJECTIVE At the conclusion of this learning activity, participants should recognize groups at high risk for community-acquired MSRA infections and manage these infections appropriately.
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Affiliation(s)
- Dirk M Elston
- Department of Dermatology, Geisinger Medical Center, Danville, PA 17821, USA.
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19
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Daniel Mullins C, Kuznik A, Shaya FT, Obeidat NA, Levine AR, Liu LZ, Wong W. Cost-effectiveness analysis of linezolid compared with vancomycin for the treatment of nosocomial pneumonia caused by methicillin-resistant Staphylococcus aureus. Clin Ther 2006; 28:1184-1198. [PMID: 16982296 DOI: 10.1016/j.clinthera.2006.08.016] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2006] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study compared the cost-effectiveness of linezolid and vancomycin in the treatment of patients with nosocomial pneumonia (NP) caused by methicillin-resistant Staphylococcus aureus (MRSA). METHODS A retrospective decision-analytic model was applied to pooled data from 2 prospective, randomized, controlled, double-blind studies, and claims data from a large health plan (3.3 million members) located in the Mid-Atlantic region. Using hospital claims for patients in the health plan with suspected NP, we then determined their daily billed (submitted) hospital charges for 4 mutually exclusive potential health outcomes of linezolid or vancomycin treatment: survival with bacteremia, survival without bacteremia, nonsurvival with bacteremia, and nonsurvival without bacteremia. To generate the expected total daily billed hospital charge for each drug-treatment group, we weighted the determined daily billed hospital charges by the probabilities of each outcome developing in each treatment arm, as derived from the clinical-trial data. Drug acquisition costs were then incorporated, and the difference in expected total costs relative to the difference in rates of survival between the linezolid and vancomycin arms was used to calculate the incremental cost-effectiveness ratio (ICER) for linezolid. RESULTS Costs were higher for nonsurviving patients compared with surviving patients. Estimated median daily billed treatment charges were $2888 for linezolid and $2993 for vancomycin. Based on Monte Carlo simulations, the respective 95% CIs were $2671 to $3106 and $2615 to $3372. Using mean treatment durations of 11.3 and 10.7 days, respectively, we obtained expected total hospitalization charges of $32,636 for linezolid treatment (95% CI, $30,182-$35,098), compared with $32,024 for vancomycin treatment (95% CI, $27,978-$36,078). The ICER for linezolid per life saved was $3600. CONCLUSIONS The higher acquisition cost of linezolid was almost completely offset by improved survival and a reduction in health care costs associated with improved survival. As a result, linezolid was almost cost-neutral compared with vancomycin in the treatment of NP caused by MRSA.
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Affiliation(s)
- C Daniel Mullins
- University of Maryland School of Pharmacy, Baltimore, Maryland, USA.
| | - Andreas Kuznik
- University of Maryland School of Pharmacy, Baltimore, Maryland, USA
| | - Fadia T Shaya
- University of Maryland School of Pharmacy, Baltimore, Maryland, USA
| | - Nour A Obeidat
- University of Maryland School of Pharmacy, Baltimore, Maryland, USA
| | - Andrew R Levine
- University of Maryland School of Pharmacy, Baltimore, Maryland, USA
| | - Larry Z Liu
- US Outcomes Research, Pfizer Inc., New York, New York, USA
| | - Winston Wong
- Pharmacy Management, CareFirst BlueCross BlueShield of Maryland Inc., Baltimore, Maryland, USA
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