RESUMO
OBJECTIVES: 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. DESIGN: An economic post hoc evaluation of a randomized, double-blind, multicenter phase 4 study was carried out. Scope: Nosocomial pneumonia due to MRSA in hospitalized adults. PARTICIPANTS: The modified intent to treat (mITT) population comprised 224 linezolid- and 224 vancomycin-treated patients. INTERVENTIONS: Costs and HCRU were evaluated between patients administered either linezolid or vancomycin, and between patients who developed renal failure and those who did not. Primary endpoints: Analysis of HCRU outcomes and costs. RESULTS: 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). CONCLUSIONS: 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
OBJETIVOS: Analizar la utilización de recursos sanitarios (URS) y los costes de la neumonía nosocomial por Staphylococcus aureus resistente a meticilina en adultos hospitalizados tratados con linezolid o vancomicina. También se evaluó el porcentaje de fallo renal entre dichos pacientes. DISEÑO: Análisis post-hoc de un ensayo clínico fase IV multicéntrico, aleatorizado, doble ciego. Ámbito: Pacientes adultos, hospitalizados con neumonía nosocomial por Staphylococcus aureusresistente a meticilina. PARTICIPANTES: Pacientes tratados con linezolid (224) o vancomicina (224). INTERVENCIONES: Desde la perspectiva española se compararon costes y URS entre pacientes tratados con linezolid o vancomicina y entre los que desarrollaron fallo renal y los que no. Principales variables de interés Análisis de costes y URS. RESULTADOS: Los costes totales fueron similares (p = 0,69) en los pacientes tratados con linezolid (17.782 ± 9.615€) o vancomicina (17.423 ± 9.460 €). La tasa de fallo renal fue significativamente menor en los tratados con linezolid (4 vs. 15%, p < 0,001). Los costes totales fueron mayores en aquellos que desarrollaron fallo renal (19.626 ± 10.840€ vs. 17.388 ± 9.369€, p = 0,14). La URS (días de ventilación mecánica: 13,2 ± 10,7 vs. 7,6 ± 3,6, p = 0,21; días en UCI: 14,4 ± 10,5 vs. 9,9 ± 6,6, p = 0,30; días de hospitalización: 19,5 ± 9,5 vs. 16,1 ± 11,0, p = 0,26) y los costes totales (17.219 ± 8.792€ vs. 20.263 ± 11.350€, p = 0,51) tendieron a ser inferiores en los pacientes tratados con linezolid que desarrollan fallo renal. Tras corregir el análisis por mortalidad, los costes diarios por paciente fueron similares (1.000 vs. 1.010€; p = 0,98). CONCLUSIONES: Desde la perspectiva española, no hubo diferencias en la URS y los costes entre los pacientes con neumonía tratados con linezolid o vancomicina. El coste de linezolid fue contrarrestado por la menor incidencia de fallo renal
