Análise clínica e econômica do linezolida para o tratamento de infecções complicadas de pele e tecidos moles confirmadas por Staphylococcus aureus resistente à meticilina no sistema de saúde privado brasileiro

Abstract

Objetives: To estimate the cost-effectiveness of linezolid for the treatment of methicillin resistant staphylococcus aureus (MRSA) confirmed complicated skin and soft tissue infections (cSSTI) under the Brazilian private healthcare system perspective. Methods: A cost-effectiveness analysis was developed based in a decision tree model to simulate 28 days of treatment. A systematic revision of the literature was developed over the efficacy and safety of the use of linezolid, vancomicin, daptomicin and teicoplanin in patients diagnosed with MRSA-confirmed cSSTI. Efficacy data used to input the economic model is informed in a published meta-analysis. In this meta-analysis pooled efficacy estimates were generated from clinical and microbiological determinations of success for the MRSA-subgroups in cSSTI clinical trials using a Bayesian meta-analytic approach (treatment success rate: linezolide-84.4%, vancomicin-74.7%, daptomicina-78.1% and teicoplanina-74.7%). The treatment duration was 14 days for each first line treatment and more 14 days for the second line treatment. Patients in treatment with linezolid stay 8 days in the hospital using venous linezolid and complete the treatment with oral linezolid during 6 days, based on Itani et al. 2010. Patients in treatment with vancomicin, daptomicin or teicoplanin stay 14 days in the hospital using venous drugs. The costs and consequences of the disease treatment were computed for each treatment alternative. Only direct medical costs were considered based in official Brazilian costs databases. Results: The incremental cost-effectiveness analysis demonstrated that linezolide is the most economically attractive drug, with better efficacy and lower cost than the comparators. The total cost per patient with linezolide, vancomicin, daptomicin and teicoplanina were BRL26,365/USD12,861, BRL36,421/USD17,766, BRL37,651/USD18,366, BRL37,984/USD18,529, respectively. (US$ 1 = R$ 2.05). Conclusions: Linezolid is the best therapeutic option, with better efficacy and safety and lower cost, versus vancomicin, daptomicin and teicoplanin for the treatment of patients diagnosed with MRSA-confirmed cSSTI under Brazilian private perspective.