Journal Article

Cost-Effectiveness of Daptomycin versus Vancomycin and Gentamicin for Patients with Methicillin-Resistant <i>Staphylococcus aureus</i> Bacteremia and/or Endocarditis

S. M. Bhavnani, A. Prakhya, J. P. Hammel and P. G. Ambrose

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 49, issue 5, pages 691-698
Published in print September 2009 | ISSN: 1058-4838
Published online September 2009 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/604710
Cost-Effectiveness of Daptomycin versus Vancomycin and Gentamicin for Patients with Methicillin-Resistant Staphylococcus aureus Bacteremia and/or Endocarditis

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Background. 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.

Methods. With use of data from an open-label, randomized, double-blind 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.

Results. 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.

Conclusions. 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.

Journal Article.  3526 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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