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Cost-effectiveness analysis just published in CID. They found the cost of daptomycin to be similar to vanco/gent for MRSA +/- endocarditis. Anybody think this is going to have any sort of an impact on the way people use the drugs? I personally would have liked gent to be included in the daptomycin arm as well, at least in endocarditis cases.
Bhavnani SM; Prakhya A; Hammel JP; Ambrose PG. Cost-Effectiveness of Daptomycin versus Vancomycin and Gentamicin for Patients with Methicillin-Resistant Staphylococcus aureus Bacteremia and/or Endocarditis. Clin Infect Dis 2009;49:691-698
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 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 (); $4582 (range, $1109$21,882) and $1635 (range, $163$33,444) for stratum 2 (
); $23,639 (range, $6225$141,132) and $26,073 (range, $5349$187,287) for stratum 3 (
). 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;
). 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.
