Pharmacoeconomic analysis of the treatment of methicillin-resistant Staphylococcus aureus with daptomycin or vancomycin

• Published in: Revista española de quimioterapia Vol. 25; no. 4; pp. 283 - 292
• Main Authors: Rubio-Terrés, Carlos, Rubio-Rodríguez, Darío, Majos, Nuria, Grau, Santiago
• Format: Journal Article
• Language: Spanish
• Published: Spain 01.12.2012
• Subjects: Adult; Aged; Aged, 80 and over; Bacteremia - drug therapy; Bacteremia - economics; Bacteremia - microbiology; Computer Simulation; Cost-Benefit Analysis; Daptomycin - adverse effects; Daptomycin - economics; Daptomycin - therapeutic use; Drug Costs; Drug-Related Side Effects and Adverse Reactions - economics; Economics, Pharmaceutical - statistics & numerical data; Endocarditis, Bacterial - drug therapy; Endocarditis, Bacterial - economics; Endocarditis, Bacterial - microbiology; Female; Humans; Male; Methicillin-Resistant Staphylococcus aureus - drug effects; Middle Aged; Models, Economic; Monte Carlo Method; Randomized Controlled Trials as Topic - economics; Randomized Controlled Trials as Topic - statistics & numerical data; Retrospective Studies; Spain; Staphylococcal Infections - drug therapy; Staphylococcal Infections - economics; Staphylococcal Infections - microbiology; Treatment Outcome; Vancomycin - adverse effects; Vancomycin - economics; Vancomycin - therapeutic use; Young Adult; Spain
• ISSN: 1988-9518

The increased morbidity, mortality and high costs associated with bacteremia caused by methicillin-resistant Staphylococcus aureus (MRSA) is a major public health problem. Pharmacoeconomic analysis was performed to compare the efficiency of daptomycin (DAP) against vancomycin (VAN) in the treatment of this infection. Retrospective, deterministic and probabilistic cost-effectiveness analysis. The effectiveness of the treatments was estimated from the results of a randomized clinical trial, which compared DAP (6 mg / kg IV daily) and VAN (1 g IV every 12 hours), both with or without gentamicin (1 mg / kg IV every 8 hours). Resource utilization was estimated from the clinical trial of the drug datasheets and Spanish sources, the unit costs were obtained also from Spanish sources. Monte Carlo probabilistic analysis and deterministic analysis were performed. The clinical trial cure rates were higher with DAP (44.4%, 95% CI 43.5 to 45.4%) than with VAN (31.8%, 95% CI 30.9 to 32.7%) not statistically significant (p = 0.2203) but with economic impact. With DAP would occur less costs due to treatment failure (rescue antibiotics, additional tests, prolonged hospital stay and adverse reactions) than with VAN. In the base case the average cost of disease per patient was € 12,329 to € 12,696 with DAP and VAN (difference of 367 €). DAP treatment was dominant (more effective, with lower costs than VAN) both in the deterministic and probabilistic analysis. In the Monte Carlo simulation, DAP was the most cost-effective treatment in 100% of the 10,000 simulations, for a willingness to pay € 12,000 per additional cure (approximate cost of MRSA bacteraemia episode). According to this model, daptomycin is more cost-effective than vancomycin in treating MRSA bacteremia. The higher cost of acquisition of daptomycin does not imply a higher cost of treating this infection.