Shorr Andrew F, Susla Gregory M, Kollef Marin H
Pulmonary and Critical Care Medicine Service, Walter Reed Army Medical Center, Washington, DC, USA.
Crit Care Med. 2004 Jan;32(1):137-43. doi: 10.1097/01.CCM.0000104110.74657.25.
To determine the incremental cost-effectiveness of linezolid compared with vancomycin for treatment of ventilator-associated pneumonia due to Staphylococcus aureus.
Decision model analysis of the cost and efficacy of linezolid vs. vancomycin for treatment of ventilator-associated pneumonia. The primary outcome was the incremental cost-effectiveness of linezolid in terms of cost per added quality-adjusted life-year gained. Other outcomes were the marginal costs per hospital survivor and per year of life saved generated by using linezolid. Model estimates were derived from prospective trials of linezolid for ventilator-associated pneumonia and from other studies describing the costs and outcomes for ventilator-associated pneumonia.
Hypothetical cohort of 1,000 patients diagnosed with ventilator-associated pneumonia.
In the model, patients received either linezolid or vancomycin.
The incremental cost-effectiveness of linezolid was calculated as the additional quality-adjusted life-years resulting from therapy with linezolid divided by the sum of the incremental costs arising because of use of linezolid (e.g., higher direct costs for linezolid, costs per in-hospital care of survivors, and posthospitalization costs). Despite its higher cost, linezolid was cost-effective for treatment of ventilator-associated pneumonia. The cost per quality-adjusted life-year equals approximately 30,000 dollars. The model was moderately sensitive to the estimated efficacy of linezolid over vancomycin. Nonetheless, even with all inputs simultaneously skewed against, linezolid remains a cost-effective option (cost per quality-adjusted life-year approximately 100,000 dollars). Based on Monte Carlo simulation, the results of our analysis are robust across a range of model inputs and assumptions (95% confidence interval for cost per quality-adjusted life-year ranges from 23,637 dollars to 42,785 dollars).
Linezolid is a cost-effective alternative to vancomycin for the treatment of ventilator-associated pneumonia.
确定与万古霉素相比，利奈唑胺治疗金黄色葡萄球菌所致呼吸机相关性肺炎的增量成本效果。
利奈唑胺与万古霉素治疗呼吸机相关性肺炎的成本和疗效的决策模型分析。主要结局是利奈唑胺以每增加一个质量调整生命年的成本计算的增量成本效果。其他结局是使用利奈唑胺产生的每名医院幸存者的边际成本和每挽救一年生命的边际成本。模型估计值来自利奈唑胺治疗呼吸机相关性肺炎的前瞻性试验以及其他描述呼吸机相关性肺炎成本和结局的研究。
假设的1000例被诊断为呼吸机相关性肺炎的患者队列。
在模型中，患者接受利奈唑胺或万古霉素治疗。
利奈唑胺的增量成本效果计算为利奈唑胺治疗产生的额外质量调整生命年除以因使用利奈唑胺产生的增量成本之和（例如，利奈唑胺更高的直接成本、幸存者住院期间护理成本和出院后成本）。尽管成本较高，但利奈唑胺治疗呼吸机相关性肺炎具有成本效果。每质量调整生命年的成本约为30,000美元。该模型对利奈唑胺优于万古霉素的估计疗效中度敏感。尽管如此，即使所有输入同时偏向不利方向，利奈唑胺仍是一种具有成本效果的选择（每质量调整生命年成本约为100,000美元）。基于蒙特卡洛模拟，我们分析的结果在一系列模型输入和假设范围内是稳健的（每质量调整生命年成本的95%置信区间为23,637美元至42,785美元）。
利奈唑胺是治疗呼吸机相关性肺炎的一种具有成本效果的万古霉素替代药物。
