PIN51 A Cost-Effectiveness Analysis of Linezolid Versus Vancomycin for Ventilator-Associated Pneumonia Patients in Panama

Abstract

Ventilator-associated pneumonia (VAP) is the most common nosocomial infection in the intensive care unit (ICU). It's associated with significant morbidity, increasing the ICU and hospital length of stay (LOS), and raising overall costs. Panama′s statistics are similar to those reported in developed countries. Literature suggests that costs could be reduced using the most efficient empiric therapy. The aim of this study was to assess the cost-effectiveness (CE) of linezolid against generic vancomycin as an empiric therapy for VAP patients, from the health care payer's perspective. A decision-tree model was used to compare costs and effectiveness of linezolid (600mg/12 hours) and vancomycin (1g/ 12 hours) (comparator) for a cohort of patients with VAP. Effectiveness measures were: clinical and microbiological success rates, mortality rates, ICU LOS and overall costs. Effectiveness and epidemiologic data were collected from published literature. Local costs (2011 US$) were obtained from Panama′s Social Security official databases. The model used a 12-week time horizon and only direct medical costs were considered (hospital LOS, medication costs, hematologic, gastrointestinal and skin adverse events and lab exams). Monte Carlo probabilistic sensitivity analysis (PSA) was constructed. Results showed linezolid as more effective and less expensive option for VAP. Clinical success rate was higher with linezolid (64%) against vancomicyn, (59.5%). Mortality was lower with linezolid (10.13% vs. 15.74%). Average ICU LOSs was 17.4 days with linezolid and 21.26 days with vancomycin. Overall medical costs per patient were $19,507 with linezolid and $20,411 with vancomycin. CE analyses showed linezolid is the dominant strategy. Acceptability curves showed that linezolid would be cost-effective within <3 GDP per capita threshold. PSA outcomes support the robustness of these findings. This is the first CE study for VAP developed in Panamá. Linezolid resulted as the cost-saving option for treating VAP patients in the Panamanian clinical environment.