Rello J, Nieto M, Solé-Violán J, Wan Y, Gao X, Solem C T, De Salas-Cansado M, Mesa F, Charbonneau C, Chastre J
CIBERES, Universitat Autónoma de Barcelona, Spain.
Medicina Intensiva, Hospital Clínico Universitario de San Carlos, Madrid, Spain.
Med Intensiva. 2016 Nov;40(8):474-482. doi: 10.1016/j.medin.2016.01.007. Epub 2016 Apr 6.
Adopting a unique Spanish perspective, this study aims to assess healthcare resource utilization (HCRU) and the costs of treating nosocomial pneumonia (NP) produced by methicillin-resistant Staphylococcus aureus (MRSA) in hospitalized adults using linezolid or vancomycin. An evaluation is also made of the renal failure rate and related economic outcomes between study groups.
An economic post hoc evaluation of a randomized, double-blind, multicenter phase 4 study was carried out.
Nosocomial pneumonia due to MRSA in hospitalized adults.
The modified intent to treat (mITT) population comprised 224 linezolid- and 224 vancomycin-treated patients.
Costs and HCRU were evaluated between patients administered either linezolid or vancomycin, and between patients who developed renal failure and those who did not.
Analysis of HCRU outcomes and costs.
Total costs were similar between the linezolid- (€17,782±€9,615) and vancomycin-treated patients (€17,423±€9,460) (P=.69). The renal failure rate was significantly lower in the linezolid-treated patients (4% vs. 15%; P<.001). The total costs tended to be higher in patients who developed renal failure (€19,626±€10,840 vs. €17,388±€9,369; P=.14). Among the patients who developed renal failure, HCRU (days on mechanical ventilation: 13.2±10.7 vs. 7.6±3.6 days; P=.21; ICU stay: 14.4±10.5 vs. 9.9±6.6 days; P=.30; hospital stay: 19.5±9.5 vs. 16.1±11.0 days; P=.26) and cost (€17,219±€8,792 vs. €20,263±€11,350; P=.51) tended to be lower in the linezolid- vs. vancomycin-treated patients. There were no statistically significant differences in costs per patient-day between cohorts after correcting for mortality (€1000 vs. €1,010; P=.98).
From a Spanish perspective, there were no statistically significant differences in total costs between the linezolid and vancomycin pneumonia cohorts. The drug cost corresponding to linezolid was partially offset by fewer renal failure adverse events.
本研究从独特的西班牙视角出发，旨在评估住院成人中使用利奈唑胺或万古霉素治疗耐甲氧西林金黄色葡萄球菌（MRSA）所致医院获得性肺炎（NP）的医疗资源利用（HCRU）情况及治疗成本。同时还对研究组之间的肾衰竭发生率及相关经济结果进行评估。
对一项随机、双盲、多中心4期研究进行事后经济学评估。
住院成人中由MRSA引起的医院获得性肺炎。
改良意向性治疗（mITT）人群包括224例接受利奈唑胺治疗的患者和224例接受万古霉素治疗的患者。
对接受利奈唑胺或万古霉素治疗的患者之间，以及发生肾衰竭和未发生肾衰竭的患者之间的成本和HCRU进行评估。
分析HCRU结果和成本。
利奈唑胺治疗组（17,782欧元±9,615欧元）和万古霉素治疗组（17,423欧元±9,460欧元）的总成本相似（P = 0.69）。利奈唑胺治疗的患者肾衰竭发生率显著更低（4%对15%；P<0.001）。发生肾衰竭的患者总成本往往更高（19,626欧元±10,840欧元对17,388欧元±9,369欧元；P = 0.14）。在发生肾衰竭的患者中，利奈唑胺治疗组与万古霉素治疗组相比，HCRU（机械通气天数：13.2±10.7天对7.6±3.6天；P = 0.21；重症监护病房住院时间：14.4±10.5天对9.9±6.6天；P = 0.30；住院时间：19.5±9.5天对16.1±11.0天；P = 0.26）和成本（17,219欧元±8,792欧元对20,263欧元±11,350欧元；P = 0.51）往往更低。校正死亡率后，各队列之间每位患者每天的成本无统计学显著差异（1000欧元对1,010欧元；P = 0.98）。
从西班牙视角来看，利奈唑胺和万古霉素肺炎队列的总成本无统计学显著差异。利奈唑胺相应的药物成本因较少的肾衰竭不良事件而部分得到抵消。
