Mark Bounthavong

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

Abstract Objective: To evaluate the clinical and microbiological outcomes of linezolid versus vancomycin in methicillin-resistant Staphylococcus aureus (MRSA) complicated skin and soft-tissue infection (cSSTI) using a meta-analysis. Research design and methods: Clinical trials were identified using PubMed, the Cochrane Central Register of Controlled Trials, and the International Pharmaceutical Abstracts from inception to March 2009. Primary outcomes evaluated resolution of signs and symptoms of infection in clinically evaluable (CE) patients, and microbiological eradication in both the modified intent-to-treat (MITT) and MRSA evaluable (MRSA ME) patients. MITT patients had a culture-confirmed Gram-positive pathogen (S. aureus) at baseline. Secondary outcomes included mortality, adverse drug reactions (ADR), and discontinuation due to ADRs. The Mantel-Haenszel odds ratios (OR) with 95% confidence intervals (CI) were calculated using the fixed effects model based on the assumption that there was little to no heterogeneity between the studies in the primary analysis. Sensitivity analyses were performed for each outcome by removing the most weighted study. Results: Five studies with a total of 2652 patients (1361/linezolid; 1291/vancomycin) were identified. Resolution of infection in CE patients (OR = 1.41; 95% CI: 1.03, 1.95) and MITT patients (OR = 1.91; 95% CI: 1.33, 2.76) favored the use of linezolid over vancomycin, but did not remain significant after sensitivity analyses (CE: OR = 1.29; 95% CI: 0.81, 2.05; MITT: OR = 1.73; 95% CI: 0.87, 3.41). Microbiological eradication in MRSA ME patients consistently favored the use of linezolid over vancomycin (OR = 2.90; 95% CI: 1.90, 4.41). No difference in mortality was observed between the two groups (OR = 1.17; 95% CI: 0.85, 1.62). Higher proportions of linezolid patients were found to have diarrhea (119/1361 vs. 52/1291), nausea (102/1361 vs. 46/1291) and thrombocytopenia (54/1121 vs. 8/1071), whereas a higher proportion of vancomycin patients were found to have renal insufficiency compared to linezolid (16/634 vs. 4/703). Inconsistent results were seen with the incidence of anemia and rash between the base-case (anemia: OR = 1.36; 95% CI: 0.90, 2.08; rash: OR = 0.26; 95% CI: 0.10, 0.68) and sensitivity analyses (anemia: OR = 2.33; 95% CI: 1.24, 4.37; rash: OR = 0.57; 95% CI: 0.12, 2.71). Discontinuation due to ADRs was not statistically different between linezolid and vancomycin (OR = 1.06; 95% CI: 0.75, 1.51). Conclusion: Resolution of infection in CE and MITT patients were inconsistent; however, a sub-analysis revealed that linezolid was more likely to consistently achieve microbiologic eradication in MRSA ME patients. Apparent risks of thrombocytopenia, nausea, diarrhea, and possibly anemia may limit linezolid use in treating MRSA cSSTI. This study was limited due to an inability to assess for the effects of hetero-resistance and appropriate vancomycin dosing on outcomes. Moreover, the small number of studies made controlling for heterogeneity challenging.

Cost‐utility analysis of bevacizumab versus ranibizumab in neovascular age‐related macular degeneration using a Markov model

OBJECTIVE To evaluate the cost-effectiveness of intravitreal bevacizumab to ranibizumab in patients with neovascular age-related macular degeneration (AMD). METHODS A cost-utility analysis using a Markov model was performed to evaluate incremental cost-effectiveness ratio [ICER,

Revisiting the medication possession ratio threshold for adherence in lipid management.

US per quality-adjusted life year (QALY) gained] between bevacizumab and ranibizumab from a US payer perspective. Transition probabilities for ranibizumab and bevacizumab were extrapolated from published studies and local institutional data. Utility values, likewise, were obtained from another published study. Mortality rates were determined from the Centers for Disease Control 2003 Life Tables. Resource utilization and total direct costs were estimated using the Centers for Medicare and Medicaid Services and the Veterans Affairs Decision Support System. A hypothetical cohort of 1000 patients was simulated through the model for 20 years. Sensitivity analyses were performed using univariate and probabilistic sensitivity analysis (PSA) on all costs, transition probabilities and utility values. An acceptability curve was generated to illustrate the cost-effectiveness probability of bevacizumab to ranibizumab with increasing willingness-to-pay (WTP). RESULTS The cost-effectiveness ratios (CER) for bevacizumab and ranibizumab were

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

1405 per QALY and

Cost-effectiveness analysis of linezolid vs. vancomycin in treating methicillin-resistant Staphylococcus aureus complicated skin and soft tissue infections using a decision analytic model.

12,177 per QALY, respectively. The ICER for bevacizumab was dominant compared to ranibizumab. The base-case CER was sensitive to drug costs of the study medications with a breakeven point of

Implementing a comprehensive, 24-hour emergency department pharmacy program

44 for ranibizumab and

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

2666 for bevacizumab. PSA revealed a 95% probability of bevacizumab being more cost-effective than ranibizumab at a WTP of

Cost Utility of Tumour Necrosis Factor-α Inhibitors for Rheumatoid Arthritis

50,000 per QALY gained. CONCLUSION Based on a WTP defined at

Cost Utility of Tumour Necrosis Factor-α Inhibitors for Rheumatoid Arthritis: An Application of Bayesian Methods for Evidence Synthesis in a Markov Model

50,000 per QALY gained, bevacizumab was cost-effective versus ranibizumab 95% of the time because of lower acquisition costs and increased efficacy.

Measuring patient satisfaction in the Pharmacy Specialty Immunization Clinic: a pharmacist-run immunization clinic at the Veterans Affairs San Diego Healthcare System.

Abstract Objective: We sought to evaluate the relationship between different levels of medication possession ratio (MPR) attained and achievement of clinically meaningful reductions in lipid levels. Research design and methods: This was a retrospective cohort study of 4691 new statin users from the Department of Veteran Affairs (VA). Subjects were required to be eligible for VA medical and pharmacy services throughout the 1 year study period from index date and to have complete data for exposure, outcome, and adjustment variables. MPR was defined as number of days supplied with prescription medication divided by days of observation. Main outcome measures: Achieving 25% or greater reduction from baseline in lipid levels for three lipid outcomes: non-high-density lipoprotein (non-HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, and total cholesterol (TC). Results: We observed a statistically significant trend of an increasing proportion of study subjects achieving a 25% reduction or more for all three lipid outcomes (p-values <0.001 for each of the three outcomes using the Cochran–Armitage trend test). Using multiple logistic regression, odds ratios (ORs) for each of the three outcomes were at a maximum for the 0.9–1.0 MPR category with ORs of 12.90 (95% confidence interval (CI), 9.60, 17.35) for the non-HDL cholesterol outcome; 11.29 (95% CI, 8.61, 14.80) for the LDL cholesterol outcome; and 9.11 (95% CI, 6.62, 12.53) for the TC outcome. Direct comparison of the 0.9–1.0 MPR category versus the 0.8–0.89 MPR category demonstrated an increase in odds of achieving 25% or more reduction for all three lipid outcomes. Conclusions: We conclude that significant improvements in outcomes are achieved with higher MPR thresholds than commonly targeted. The authors propose consideration of an MPR-adherence threshold of 0.9 MPR. Limitations include the possible modification of study findings in non-VA settings. MPR is a secondary adherence measure based on refill frequency.