PRS13 - Budget Impact Analysis of Step-Down Strategy Versus Conventional Therapy in the Treatment of Nosocomial Pneumonia Caused by Gram Positive Bacteria in Mexico

Abstract

Previous reports of national literature estimated 15,135 cases of nosocomial pneumonia caused by Gram-positive bacteria (GPB) in Mexico, of which approximately 51% (95%CI 43%-59%) are candidates to use the step-down strategy (SDS) with linezolid. The aim of the study was to estimate the budget impact of SDS vs conventional strategy (CS, only intravenous) with linezolid in Mexico, from the perspective of Instituto Mexicano del Seguro Social (IMSS). Budget impact analysis (BIA) considered direct medical costs of linezolid (intravenous and tablets), length of stay, physician visits, route of administration, laboratory and imaging tests, as well as outpatient control (unit costs extracted from IMSS sources). Costs are expressed in 2013 US$ (1US$:€0.719). The resource use profile was estimated by Delphi method in a panel of 10 experienced infectologists. A BIA considering two scenarios was performed: i) budget impact of use CS in 100% of cases of nosocomial pneumonia caused by GPB (15,135) and ii) budget impact of use of SDS only in candidates (7,718 cases), based on the National budget allocated to health in 2013. The per-patient average treatment cost (ATC) of SDS was $10,116 ($9,345-10,887) whereas the per-patient ATC of CS was $17,251 ($16,379-18,124). The scenario i) represents 2.79% of National budget allocated to health, whereas scenario ii) represents 2.19%. This means potential savings of 0.6% of National budget allocated to health ($55,078,697). With these resources, CS treatment could be provided to 3,192 additional nosocomial pneumonia patients caused by GPB in Mexico. In the Mexican setting, SDS with linezolid in suitable patients is an intervention that could promote significant savings regarding the use of only intravenous form of the drug, which represents an opportunity to allocate scarce resources in a more efficient way.