Tan Seng C, Wang Xue, Wu Benquan, Kang Hongjun, Li Qiang, Chen Yixi, Chen Chieh-I, Hajek Petr, Patel Dipen A, Gao Xin
Health Economics & Outcomes Research, IMS Health Asia Pacific, Singapore.
ICU, First Affiliated Hospital of Medical College of Xi'an Jiao Tong University, Xi'an, China.
Value Health Reg Issues. 2014 May;3:94-100. doi: 10.1016/j.vhri.2014.03.002. Epub 2014 May 10.
To estimate the cost-effectiveness of intravenous linezolid as a first-line agent against intravenous vancomycin in treating methicillin-resistant Staphylococcus aureus-confirmed nosocomial pneumonia in four Chinese cities.
A decision-analytic model of 4-week time horizon was used to conduct cost-effectiveness analyses from the payer's perspective. Clinical outcomes and resource use data were derived from a head-to-head trial, supplemented with local cost estimates based on hospital data via an expert panel. A series of scenario analyses were conducted to evaluate the impact of uncertainty around model inputs. All results were reported in 2012 Chinese Renminbi.
The predicted probability of overall treatment success was 0.629 and 0.602 for linezolid and vancomycin, respectively. Total inpatient costs varied across the four cities, ranging from ¥58,835 to ¥86,894 for linezolid and ¥58,390 to ¥87,033 for vancomycin, respectively. Linezolid was demonstrated to be a dominant treatment strategy in Guangzhou. In Beijing, Nanjing, and Xi'an, incremental cost-effectiveness ratios in terms of additional successfully treated patient were ¥1,861, ¥163, and ¥16,509, respectively. Dominance by linezolid was observed in some scenario analyses with parameters such as treatment duration, inclusion of cost of managing adverse events, and drug acquisition costs being the main drivers of cost-effectiveness results.
Despite linezolid's higher drug acquisition cost, its superior clinical efficacy renders it a likely cost-effective alternative for the treatment of methicillin-resistant Staphylococcus aureus-confirmed nosocomial pneumonia as compared with branded vancomycin from the payer perspectives of Beijing, Guangzhou, Nanjing, and Xi'an.
评估在中国四个城市，静脉注射利奈唑胺作为一线药物治疗耐甲氧西林金黄色葡萄球菌确诊的医院获得性肺炎，相对于静脉注射万古霉素的成本效益。
采用为期4周的决策分析模型，从支付方的角度进行成本效益分析。临床结果和资源使用数据来自一项头对头试验，并通过专家小组根据医院数据补充当地成本估算。进行了一系列情景分析，以评估模型输入不确定性的影响。所有结果均以2012年人民币报告。
利奈唑胺和万古霉素总体治疗成功的预测概率分别为0.629和0.602。四个城市的住院总费用各不相同，利奈唑胺为58,835元至86,894元，万古霉素为58,390元至87,033元。利奈唑胺在广州被证明是一种占优的治疗策略。在北京、南京和西安，每多成功治疗一名患者的增量成本效益比分别为1,861元、163元和16,509元。在一些情景分析中，观察到利奈唑胺占优，治疗持续时间、管理不良事件成本的纳入以及药品采购成本等参数是成本效益结果的主要驱动因素。
尽管利奈唑胺的药品采购成本较高，但从北京、广州、南京和西安支付方的角度来看，其卓越的临床疗效使其在治疗耐甲氧西林金黄色葡萄球菌确诊的医院获得性肺炎方面可能是一种具有成本效益的替代方案，优于品牌万古霉素。
