Grau S, Aguado J M, Mateu-de Antonio J, Gonzalez P, Del Castillo A
Infectious Disease Control, Pharmacy Department, Hospital del Mar, Barcelona, Spain.
J Chemother. 2007 Aug;19(4):398-409. doi: 10.1179/joc.2007.19.4.398.
The aim of this study was to perform a comparative cost-effectiveness analysis of linezolid vs teicoplanin (i.v., switching to oral/i.m. respectively) in Spain. A decision tree model was used with the results of a randomized, comparative, controlled clinical trial with linezolid vs teicoplanin in the treatment of infections caused by Gram-positive microorganisms, with a timeline of 31 days. The efficacy endpoint was the percentage of patients with clinical healing or improvement in their infection. Direct medical costs were included using Spanish 2005 prices. Average cost per patient, average cost-effectiveness ratio and several sensitivity analyses were carried out. In the intent-to-treat (ITT) analysis linezolid obtained a higher percentage of therapeutic success than teicoplanin (95.5% vs 87.6% respectively, p = 0.005), both with similar tolerability. The average cost per treated patient was euro 8,064.76 for linezolid vs euro 8,727.36 for teicoplanin, with an incremental cost of euro 622.59 (-7,6%). Linezolid yielded a lower average cost-effectiveness ratio, euro 8,444.78 (8,195.90 - 8,709.25) than teicoplanin, euro 9,962.74 (9,465.68 - 10,502.23), with a slight reduction in average cost per successfully treated patient of 15.2% ( euro 1,517.96). The results were robust to the sensitivity analysis. In conclusion, linezolid is a more cost-effective option than teicoplanin in the treatment of infections caused by Gram-positive microorganisms, since it offers superior clinical benefits with a lower use of associated resources.
本研究的目的是在西班牙对利奈唑胺与替考拉宁（分别静脉给药，后改为口服/肌内注射）进行成本效益比较分析。使用决策树模型，其依据是一项关于利奈唑胺与替考拉宁治疗革兰氏阳性微生物感染的随机、对照临床试验结果，时间跨度为31天。疗效终点是感染临床治愈或改善的患者百分比。采用西班牙2005年价格纳入直接医疗成本。计算了每位患者的平均成本、平均成本效益比，并进行了多项敏感性分析。在意向性治疗（ITT）分析中，利奈唑胺的治疗成功率高于替考拉宁（分别为95.5%和87.6%，p = 0.005），两者耐受性相似。利奈唑胺治疗每位患者的平均成本为8064.76欧元，替考拉宁为8727.36欧元，增量成本为622.59欧元（-7.6%）。利奈唑胺的平均成本效益比为8444.78欧元（8195.90 - 8709.25），低于替考拉宁的9962.74欧元（9465.68 - 10502.23），成功治疗的每位患者平均成本略有降低，为15.2%（1517.96欧元）。结果对敏感性分析具有稳健性。总之，在治疗革兰氏阳性微生物感染方面，利奈唑胺比利奈唑胺更具成本效益，因为它能提供更好的临床效益，同时减少相关资源的使用。
