PRS21 Cost-Effectiveness Analysis of Linezolid Versus Vancomycin for Ventilator-Associated Pneumonia Patients in the Dominican Republic Public Case

Abstract

Ventilator-associated pneumonia (VAP) is a serious complication of mechanical ventilation (MV) and is associated with an increased in mortality and in the intensive care unit (ICU) length of stay (LOS). The increasing prevalence of Methicillin Resistant Staphylococcus aureus in both hospital and community settings presents substantial higher costs which could be reduced using the most efficient empiric therapy. The aim of this study was to assess the cost-effectiveness (CE) of linezolid against vancomycin as an empiric therapy for VAP patients. The study included a cohort of adult patients with VAP in the ICU and it used a 12-week time horizon with the aid of a decision-tree model to compare costs and effectiveness of linezolid (600mg/12 hours) and vancomycin (15mg/Kg 12 hours) (standard of care). Effectiveness measures were: clinical success rates, mortality rates, ICU LOS and hospital LOS. The epidemiological data was collected from published literature and local costs (2011 US$) were obtained from public hospitals official databases. Only direct medical costs were considered (LOS, medication costs, hematologic, gastrointestinal and lab exams). Monte Carlo probabilistic sensitivity analysis (PSA) was developed. Results showed linezolid as a more effective and less expensive option for VAP adult patients in comparison with vancomycin. Mortality rate was lower with linezolid (10.13% vs. 15.74%) while clinical success rate was higher with linezolid (64%) against vancomicyn (59.5%). ICU LOS was 17.4 days for linezolid and 21.26 days for vancomycin. Hospital LOS was 8.44 days for linezolid and 9.43 days for vancomycin. Overall medical costs per patient were US$35,077.18 with linezolid and US$39,980.57 with vancomycin. CE analyses showed linezolid as cost-saving (dominant strategy). PSA outcomes support the robustness of these findings. The empiric use of linezolid in UCI for adults with VAP would result in economic and health benefits for the Dominican Republic's public environment.