1052. Cost-Effectiveness of Daptomycin versus Vancomycin in the Treatment of Patients with Methicillin-Resistant Staphylococcus aureus Bloodstream Infections
Session: Poster Abstract Session: Stewardship: Improving Treatments
Friday, October 4, 2013
Room: The Moscone Center: Poster Hall C
Background:

Methicillin-resistant Staphylococcus aureus (MRSA) has become an increasingly predominant pathogen in bloodstream infections and is associated with significantly increased costs compared to methicillin-sensitive Staphylococcus aureus. Concern over rising minimum inhibitory concentrations to vancomycin has led to increased use of alternative therapies, such as daptomycin, which are more expensive but have demonstrated cost-effectiveness due to decreased length of antibiotic therapy and decreased length of stay. As a quality control assessment for our antimicrobial stewardship program, we evaluated MRSA bloodstream infections to determine the cost-effectiveness of daptomycin versus vancomycin therapy.

Methods:

Patients were retrospectively selected by positive blood culture with MRSA between July 1st, 2011 through December 31st, 2012. Patients were categorized into one of three groups: treatment with vancomycin alone, treatment with daptomycin alone, or initial vancomycin treatment with subsequent switch to daptomycin. We compared length of stay (LOS), total direct hospital cost (TDHC), total infection-related cost (TIRC), and in-hospital mortality.

Results:

102 patients received vancomycin alone, 9 received daptomycin alone, and 51 received vancomycin then were switched to daptomycin. The daptomycin and vancomycin groups differed numerically in LOS (12.1 days vs 15.1 days; p=0.60) and were comparable in TDHC ($24,883 vs $25,663; p=0.32). Compared to the vancomycin group, the group switched from vancomycin to daptomycin had a statistically significant higher LOS (17.9 days vs 15.1 days; p=0.02), TDHC ($38,476 vs $25,663; p=0.0001), and TIRC ($31,793 vs $16,703; p<0.001). There was no statistically significant difference in mortality between the three groups.

Conclusion:

Despite the higher cost of daptomycin, patients had a numerically lower LOS and comparable TDHC when treated with daptomycin alone versus vancomycin alone. This was likely not statistically significant due to the low power of the study. Patients treated initially with vancomycin then switched to daptomycin had an increase in all endpoints except mortality compared to those treated with vancomycin alone. Patient level clinical characteristics need further evaluation.

Amber Vasquez, MD, Internal Medicine - Infectious Diseases, The Ohio State University, Columbus, OH, Kurt Stevenson, MD, MPH, Ohio State University Wexner Medical Center, Columbus, OH and Jessica E. West, MSPH, Infectious Diseases, The Ohio State University Wexner Medical Center, Columbus, OH

Disclosures:

A. Vasquez, None

K. Stevenson, None

J. E. West, None

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