McCollum Marianne, Rhew David C, Parodi Stephen
Department of Clinical Pharmacy, University of Colorado Health Sciences Center School of Pharmacy, Denver, Colorado 80262, USA.
Clin Ther. 2003 Dec;25(12):3173-89. doi: 10.1016/s0149-2918(03)90101-9.
Infections with methicillin-resistant Staphylococcus species (MRSS) are associated with higher treatment costs than infections with methicillin-sensitive Staphylococcus species in the United States--partly because of an increased length of hospital stay (LOS).
This study used pharmacoeconomic modeling to evaluate the costs and outcomes associated with the use of i.v. vancomycin compared with p.o. linezolid in the treatment of MRSS-infected patients.
A retrospective chart review was used to determine the number of cases with confirmed or presumed MRSS infections treated with i.v. vancomycin during calendar-year 2000 at the Veterans Affairs Greater Los Angeles Healthcare System inpatient facility. Patients who were eligible for a switch to p.o. linezolid with or without early discharge to home were identified. Cost differences associated with conversion from i.v. to p.o. therapy (compared with continued i.v. therapy) were estimated based on a mean decreased LOS and a decrease in the costs associated with catheter-related adverse events. Rates and costs of catheter-related adverse events were based on estimates from the literature. Sensitivity analyses were performed by variation of the estimated mean LOS decrease in the SD and by variation of the estimates for incidence and costs related to catheter complications. Costs were measured in year 2000 US dollars, and differences were not assessed for statistical significance.
Of 177 patients treated with i.v. vancomycin, 103 (58%) were eligible for conversion to p.o. linezolid and 55 (31%) were eligible for early discharge from the hospital with continuation of p.o. therapy. Early discharge was associated with a mean (SD) LOS decrease of 3.3 (2.9) days. Annual mean total cost savings in patients eligible for conversion from i.v. vancomycin to p.o. linezolid with early discharge were $294,750 (range, $35,730-$553,790). For cases eligible for inpatient conversion from i.v. vancomycin to p.o. linezolid therapy (n=48), the mean total annual cost difference was an increase of $6340 for p.o. linezolid (range, -$12,910 to $11,900).
These results--although partly based on estimates from the literature, rather than direct measurements--support the use of p.o. linezolid with or without early discharge as a potential cost-savings alternative for eligible patients treated with a full course of i.v. vancomycin for suspected or confirmed MRSS infection.
在美国，耐甲氧西林葡萄球菌属（MRSS）感染比甲氧西林敏感葡萄球菌属感染的治疗成本更高，部分原因是住院时间（LOS）延长。
本研究采用药物经济学模型，评估静脉注射万古霉素与口服利奈唑胺治疗MRSS感染患者的成本和结局。
采用回顾性病历审查，确定2000年在洛杉矶退伍军人事务部大医疗系统住院设施接受静脉注射万古霉素治疗的确诊或疑似MRSS感染病例数。确定有资格转为口服利奈唑胺（无论是否提前出院回家）的患者。根据平均住院时间缩短和与导管相关不良事件相关成本的降低，估计从静脉治疗转为口服治疗（与持续静脉治疗相比）的成本差异。导管相关不良事件的发生率和成本基于文献估计。通过改变估计的平均住院时间缩短的标准差以及改变与导管并发症相关的发生率和成本估计值进行敏感性分析。成本以2000年美元衡量，差异未进行统计学显著性评估。
在177例接受静脉注射万古霉素治疗的患者中，103例（58%）有资格转为口服利奈唑胺，55例（31%）有资格在继续口服治疗的情况下提前出院。提前出院与平均（标准差）住院时间缩短3.3（2.9）天相关。有资格从静脉注射万古霉素转为口服利奈唑胺并提前出院的患者每年平均总成本节省294,750美元（范围为35,730 - 553,790美元）。对于有资格从静脉注射万古霉素转为口服利奈唑胺进行住院治疗的病例（n = 48），口服利奈唑胺的年平均总成本差异为增加6340美元（范围为 - 12,910至11,900美元）。
这些结果——尽管部分基于文献估计而非直接测量——支持对于疑似或确诊MRSS感染接受全程静脉注射万古霉素治疗的合格患者，使用口服利奈唑胺（无论是否提前出院）作为一种潜在的成本节约替代方案。
