Bhavnani S M, Prakhya A, Hammel J P, Ambrose P G
Institute for Clinical Pharmacodynamics at Ordway Research Institute, Albany, New York, USA.
Clin Infect Dis. 2009 Sep 1;49(5):691-8. doi: 10.1086/604710.
Methicillin-resistant Staphylococcus aureus (MRSA) is an increasingly common cause of bacteremia and endocarditis. The cost-effectiveness (CE) of daptomycin was compared with that of vancomycin-gentamicin in patients with MRSA bacteremia with or without endocarditis.
With use of data from an open-label, randomized study comparing daptomycin with vancomycin-gentamicin in the aforementioned patient population, 3 cost strata were considered: (1) study drug acquisition (daptomycin, $0.37/mg; vancomycin, $7/g; and gentamicin, $0.12/mg); (2) stratum 1 plus the cost of therapy for treatment failures and adverse events, therapeutic drug monitoring, and preparation and administration of all medications; and (3) stratum 2 plus hospital bed costs. Drug costs were based on mean wholesale price, with other costs based on those for a typical community hospital. Cost-effectiveness ratios were calculated as cost divided by proportion of successes. Sensitivity analyses were performed by varying the study drug cost.
Forty-five (20 successes) and 44 (14 successes) patients received daptomycin and vancomycin-gentamicin, respectively. The respective median cost-effectiveness ratios for daptomycin and vancomycin-gentamicin for each cost stratum were as follows: $4082 (range, $1062-$13,893) and $560 (range, $66-$1649) for stratum 1 (P < .001); $4582 (range, $1109-$21,882) and $1635 (range, $163-$33,444) for stratum 2 (P = .026); $23,639 (range, $6225-$141,132) and $26,073 (range, $5349-$187,287) for stratum 3 (P = .82). Sensitivity analyses indicated that if the cost of vancomycin was $0, strata 3 cost-effectiveness ratios did not differ ($23,639 and $25,668, respectively; P = .85). Similar results between groups were seen among patients with bacteremia.
When all costs of therapy were considered, the cost-effectiveness of daptomycin and vancomycin-gentamicin was similar, even if the cost of vancomycin was $0.
耐甲氧西林金黄色葡萄球菌（MRSA）是菌血症和心内膜炎日益常见的病因。在患有或未患有心内膜炎的MRSA菌血症患者中，比较了达托霉素与万古霉素 - 庆大霉素的成本效益（CE）。
利用一项开放标签、随机研究的数据，该研究在上述患者群体中比较了达托霉素与万古霉素 - 庆大霉素，考虑了3个成本层次：（1）研究药物采购（达托霉素，0.37美元/毫克；万古霉素，7美元/克；庆大霉素，0.12美元/毫克）；（2）层次1加上治疗失败和不良事件的治疗成本、治疗药物监测以及所有药物的配制和给药成本；（3）层次2加上医院床位成本。药物成本基于平均批发价格，其他成本基于典型社区医院的成本。成本效益比计算为成本除以成功比例。通过改变研究药物成本进行敏感性分析。
分别有45例（20例成功）和44例（14例成功）患者接受了达托霉素和万古霉素 - 庆大霉素治疗。每个成本层次下达托霉素和万古霉素 - 庆大霉素各自的中位数成本效益比分别如下：层次1为4082美元（范围为1062 - 13893美元）和560美元（范围为66 - 1649美元）（P < 0.001）；层次2为4582美元（范围为1109 - 21882美元）和1635美元（范围为163 - 33444美元）（P = 0.026）；层次3为23639美元（范围为6225 - 141132美元）和26073美元（范围为5349 - 187287美元）（P = 0.82）。敏感性分析表明，如果万古霉素成本为0，层次3的成本效益比没有差异（分别为23639美元和25668美元；P = 0.85）。在菌血症患者组之间也观察到类似结果。
当考虑所有治疗成本时，即使万古霉素成本为0，达托霉素和万古霉素 - 庆大霉素的成本效益也相似。
