E von Dach1, C M Morel2, A Murthy3, L Pagani4, M Macedo-Vinas5, F Olearo6, S Harbarth7. 1. Infection Control Programme, Geneva University Hospitals and Medical School, Geneva, Switzerland. 2. Infection Control Programme, Geneva University Hospitals and Medical School, Geneva, Switzerland; London School of Economics, London, UK. 3. Incyte Corporation, Epalinges, Switzerland. 4. Infectious Diseases Unit, Bolzano Central Hospital, Bolzano, Italy; Antimicrobial Stewardship Programme, Annecy-Genevois Hospital Centre, Annecy, France. 5. Dpto de Laboratorio de Patología Clínica, Facultad de Medicina, Udelar, Uruguay. 6. Division of Infectious Diseases, Geneva University Hospitals and Medical School, Geneva, Switzerland. 7. Infection Control Programme, Geneva University Hospitals and Medical School, Geneva, Switzerland; Division of Infectious Diseases, Geneva University Hospitals and Medical School, Geneva, Switzerland. Electronic address: stephan.harbarth@hcuge.ch.
Abstract
OBJECTIVE: Few industry-independent studies have been conducted to compare the relative costs and benefits of drugs to treat methicillin-resistant Staphylococcus aureus (MRSA) infection. We performed a stochastic cost-effectiveness analysis comparing two treatment strategies-linezolid versus trimethoprim-sulfamethoxazole plus rifampicin-for the treatment of MRSA infection. METHODS: We used cost and effectiveness data from a previously conducted clinical trial, complementing with other data from published literature, to compare the two regimens from a healthcare system perspective. Effectiveness was expressed in terms of quality-adjusted life-years (QALYs). Several sensitivity analyses were performed using Monte Carlo simulation, to measure the effect of potential parameter changes on the base-case model results, including potential differences related to type of infection and drug toxicity. RESULTS: Treatment of MRSA infection with trimethoprim-sulfamethoxazole plus rifampicin and linezolid were found to cost on average €146 and €2536, and lead to a gain of 0.916 and 0.881 QALYs, respectively. Treatment with trimethoprim-sulfamethoxazole plus rifampicin was found to be more cost-effective than linezolid in the base case and remained dominant over linezolid in most alternative scenarios, including different types of MRSA infection and potential disadvantages in terms of toxicity. With a willingness-to-pay threshold of €0, €50 000 and €200 000 per QALY gained, trimethoprim-sulfamethoxazole plus rifampicin was dominant in 100%, 96% and 85% of model iterations. A 95% discount on the current purchasing price of linezolid would be needed when it goes off-patent for it to represent better value for money compared with trimethoprim-sulfamethoxazole plus rifampicin. CONCLUSIONS: Combined treatment of trimethoprim-sulfamethoxazole plus rifampicin is more cost-effective than linezolid in the treatment of MRSA infection.
OBJECTIVE: Few industry-independent studies have been conducted to compare the relative costs and benefits of drugs to treat methicillin-resistant Staphylococcus aureus (MRSA) infection. We performed a stochastic cost-effectiveness analysis comparing two treatment strategies-linezolid versus trimethoprim-sulfamethoxazole plus rifampicin-for the treatment of MRSA infection. METHODS: We used cost and effectiveness data from a previously conducted clinical trial, complementing with other data from published literature, to compare the two regimens from a healthcare system perspective. Effectiveness was expressed in terms of quality-adjusted life-years (QALYs). Several sensitivity analyses were performed using Monte Carlo simulation, to measure the effect of potential parameter changes on the base-case model results, including potential differences related to type of infection and drug toxicity. RESULTS: Treatment of MRSA infection with trimethoprim-sulfamethoxazole plus rifampicin and linezolid were found to cost on average €146 and €2536, and lead to a gain of 0.916 and 0.881 QALYs, respectively. Treatment with trimethoprim-sulfamethoxazole plus rifampicin was found to be more cost-effective than linezolid in the base case and remained dominant over linezolid in most alternative scenarios, including different types of MRSA infection and potential disadvantages in terms of toxicity. With a willingness-to-pay threshold of €0, €50 000 and €200 000 per QALY gained, trimethoprim-sulfamethoxazole plus rifampicin was dominant in 100%, 96% and 85% of model iterations. A 95% discount on the current purchasing price of linezolid would be needed when it goes off-patent for it to represent better value for money compared with trimethoprim-sulfamethoxazole plus rifampicin. CONCLUSIONS: Combined treatment of trimethoprim-sulfamethoxazole plus rifampicin is more cost-effective than linezolid in the treatment of MRSA infection.
Authors: Ying Zhang; Yan Wang; Mieke L Van Driel; Treasure M McGuire; Tao Zhang; Yuzhu Dong; Yang Liu; Leichao Liu; Ruifang Hao; Lu Cao; Jianfeng Xing; Yalin Dong Journal: Antimicrob Resist Infect Control Date: 2019-05-06 Impact factor: 4.887
Authors: Tobias Siegfried Kramer; Frank Schwab; Michael Behnke; Sonja Hansen; Petra Gastmeier; Seven Johannes Sam Aghdassi Journal: Antimicrob Resist Infect Control Date: 2019-10-21 Impact factor: 4.887