Donald I. Hsu

Cost-Effectiveness Analysis of Linezolid, Daptomycin, and Vancomycin in Methicillin-Resistant Staphylococcus aureus: Complicated Skin and Skin Structure Infection Using Bayesian Methods for Evidence Synthesis

BACKGROUND Methicillin-resistant Staphylococcus aureus (MRSA) complicated skin and skin structure infection (cSSSI) is a prominent infection encountered in hospital and outpatient settings that is associated with high resource use for the health-care system. OBJECTIVE A decision analytic (DA) model was developed to evaluate the cost-effectiveness analysis (CEA) of linezolid, daptomycin, and vancomycin in MRSA cSSSI. METHODS Bayesian methods for evidence synthesis were used to generate efficacy and safety parameters for a DA model using published clinical trials. CEA was done from the US health-care perspective. Efficacy was defined as a successfully treated patient at the test of cure without any adverse reaction. Primary outcome was the incremental cost-effectiveness ratio between linezolid and vancomycin, daptomycin and vancomycin, and linezolid and daptomycin in MRSA cSSSI. Univariate and probabilistic sensitivity analyses were performed to test the robustness of the model. RESULTS The total direct costs of linezolid, daptomycin, and vancomycin were

Ceftolozane/tazobactam: a novel antipseudomonal cephalosporin and β-lactamase-inhibitor combination.

18,057,

Assessment of patient communication skills during OSCE: Examining effectiveness of a training program in minimizing inter-grader variability

20,698, and

Cost–effectiveness of linezolid in methicillin-resistant Staphylococcus aureus skin and skin structure infections

23,671, respectively. The cost-effectiveness ratios for linezolid, daptomycin, and vancomycin were

Present and Emerging Therapies for Methicillin-Resistant Staphylococcus aureus Skin and Soft Tissue Infections: Focus on Iclaprim

37,604,

High-dose vancomycin therapy for methicillin-resistant Staphylococcus aureus infections: efficacy and toxicity.

44,086, and

Comparison of method-specific vancomycin minimum inhibitory concentration values and their predictability for treatment outcome of meticillin-resistant Staphylococcus aureus (MRSA) infections.

52,663 per successfully treated patient, respectively. Linezolid and daptomycin were dominant strategies compared to vancomycin. However, linezolid was dominant when compared to daptomycin. The model was sensitive to the duration of daptomycin and linezolid treatment. CONCLUSION Linezolid and daptomycin are potentially cost-effective based on the assumptions of the DA model; however, linezolid appears to be more cost-effective compared to daptomycin and vancomycin for MRSA cSSSIs.

PGI21 a Comparison of the Cost-Effectiveness of Fidaxomicin, Metronidazole, and Vancomycin, in the Treatment of Clostridium Difficile-Associated Disease

The management of infections caused by multidrug-resistant Gram-negative bacteria, particularly Pseudomonas aeruginosa, continues to be a significant challenge to clinicians. Ceftolozane/tazobactam is a novel antibacterial and β-lactamase-inhibitor combination that has shown appreciable activity against wild-type Enterobacteriaceae and potent activity against P. aeruginosa. Moreover, ceftolozane/tazobactam has not demonstrated cross-resistance to other antimicrobial classes, particularly those affected by extended-spectrum β-lactamases, AmpC β-lactamase, a loss in porin channels, or the overexpression of efflux pumps in P. aeruginosa. Ceftolozane/tazobactam has completed two Phase II clinical trials in complicated intra-abdominal and complicated urinary tract infections. A Phase III, multicenter, prospective, randomized, open-label study has been initiated to evaluate the safety and efficacy of ceftolozane/tazobactam versus piperacillin/tazobactam for the treatment of ventilator-associated pneumonia. A Medline search of articles from inception to May 2013 and references for selected citations was conducted. Data from abstracts presented at conferences were also appraised. This article reviews the antimicrobial, pharmacokinetic, and pharmacodynamic profile of ceftolozane/tazobactam, and discusses its potential role in therapy.

High-DoseVancomycinTherapyforMethicillin-Resistant Staphylococcus aureus Infections

OBJECTIVE To assess effectiveness of a training program in reducing inter-grader variability in grading communication skills during an objective structured clinical exam (OSCE). METHODS Global communication (GC) skills are assessed by standardized participants (SP) and faculty during each OSCE using a 6 item rubric. Despite criteria delineated in the GC rubric, inter-grader variability was observed. During 2008-2009 academic year, a training program was implemented before each OSCE to achieve more consistent interpretation and grading in GC skills. GC grades between SP and faculty for 2nd and 3rd level student OSCEs during 2008-2009 (post-training) were compared to 2007-2008 (pre-training). Data was analyzed using repeated measures ANOVA. RESULTS 274 and 281 students participated in OSCEs during 2007-2008 and 2008-2009 academic years, respectively. Training significantly (P<.001) decreased grader variability between SPs and faculty. There was a greater mean difference between faculty vs. SP before training (faculty 14.68, SP 15.87) compared to after training (faculty 13.51, SP 13.78). Mean GC scores for both faculty and SPs also decreased significantly after training. CONCLUSION AND PRACTICE IMPLICATIONS A training program may be necessary to reduce inter-rater variability in assessment of OSCE communication skills if it is to be truly helpful to student pharmacists learning to counsel patients.

Original article Efficacy and safety of linezolid in methicillin-resistant Staphylococcus aureus (MRSA) complicated skin and soft tissue infection (cSSTI): a meta-analysis

Linezolid is a novel oxazolidinone antibacterial agent with a broad clinical application, especially in methicillin-resistant Staphylococcus aureus skin and soft-tissue infections and skin and skin-structure infections. Pharmacoeconomic advantages include decreased hospital duration, reduction in intravenous antibiotic use and early discharge opportunities that contribute to an overall reduction in healthcare resources. Linezolid’s oral formulation has a pharmacokinetic profile that is similar to its intravenous formulation, which creates opportunities for early discharge not available to comparators like vancomycin and daptomycin. Both vancomycin and daptomycin require intravenous therapy, which compounds the resources required in treating methicillin-resistant S. aureus skin and soft tissue/skin and skin structure infections. Pharmacoeconomic studies have demonstrated an overall reduction in total direct costs to the payer in favor of linezolid over its comparators. Its overall reduction in healthcare utilization makes it an appropriate alternative to the standard therapy, vancomycin.