Staphylococcus aureus (SA) is a major cause of healthcare associated pneumonia (HAP). Clinicians and stewardship programs are challenged with how to best use novel agents for SA-HAP. We developed a decision analytic model to describe health outcomes and costs associated with telavancin (TLV) relative to vancomycin (VAN) across different clinical scenarios among patients with SA-HAP.
This was a decision analytic model of hospital costs and outcomes of SA-HAP treated with TLV and VAN (Fig 1). Data on clinical cure at test of cure (TOC) [polymicrobial MSSA or MRSA infection in presence of adequate Gram-negative therapy, monomicrobial MSSA, monomicrobial MRSA VAN MIC < 1 mcg/mL or >/= 1 mcg/mL] and nephrotoxicity, as well as prevalence of polymicrobial infection (40%), MRSA (61%), and VAN MIC >/= 1 mcg/mL (85%), were obtained from ATTAIN clinical trials. Data on length of stay (LOS) for cure (10 days), failure (10 days), and nephrotoxicity (3.5 days) were based on literature. The cost per treated patient and incremental cost-effectiveness ratio (ICER) per additional cure were calculated for (1) all SA-HAP and (2) monomicrobial SA-HAP. One-way sensitivity analyses were performed.
Under the base-case scenario, hospital cost for TLV treated HAP was $43,337 and VAN $43,004; a net increase of $333 per patient. TLV was associated with higher drug (+$1,977) and nephrotoxicity costs (+$477), offset by lower ICU (-$1,615) and ventilator (-$106) costs. Overall point estimate of clinical cure at TOC was higher by 5.9% with TLV vs. VAN and ICER was $5,674 per additional cure. ICER was sensitive to probabilities of cure at TOC, ICU cost, TLV cost, and additional LOS due to failure (Fig 2). For monomicrobial SA-HAP, TLV was associated with higher clinical cure by 10.1% and net cost savings of $1,200 per treated patient.
Our decision analytic model suggests that early directed therapy with TLV for SA-HAP is associated with a modest increase in total cost, and favorable ICER relative to VAN under our base model assumptions. TLV was associated with overall cost savings for monomicrobial SA-HAP versus VAN, suggesting that optimal economic benefit from TLV may be gained from proper patient selection and early appropriate treatment for SA-HAP.
Figure SEQ Figure \* ARABIC 1: Model Structure
Figure SEQ Figure \* ARABIC 2: One-Way Sensitivity Analyses
J. A. Mckinnell,
Theravance Biopharma US Inc.:
D. Patel, Theravance Biopharma US Inc.: Consultant , Consulting fee
T. P. Lodise, Theravance Biopharma US Inc.: Consultant and Grant Investigator , Consulting fee and Grant recipient
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