The Costs and Consequences of Methicillin‐Resistant Staphylococcus aureus Infection Treatments in Canada

Abstract

BACKGROUND: A multinational randomized controlled trial has shown a trend toward early discharge of patients taking oral linezolid versus intravenous vancomycin (IV) in the treatment of methicillin-resistantStaphylococcus aureus(MRSA) infections. Infection treatments resulting in shorter hospitalization durations are associated with cost savings from the hospital perspective.OBJECTIVE: To determine whether similar economic advantages are associated with oral linezolid, the costs and consequences of linezolid use following vancomycin IV versus the existing practice in the treatment of infections caused by MRSA were compared.METHODS: The charts of all patients admitted to one of three tertiary care teaching hospitals between January 1, 1997 and August 31, 2000 and treated with vancomycin IV for an active MRSA infection (skin and soft tissue only) were reviewed. Based on the vancomycin IV chart review data set and a simulated linezolid data set, the clinical consequences and the associated costs of MRSA treatment with vancomycin IV, and oral and IV forms of linezolid were quantified and compared within the framework of a cost-consequence analysis.RESULTS: Patients treated with oral and IV forms of linezolid compared with the existing practice had a shorter length of stay and required fewer home IV care services, which resulted in a cost savings of $750 (2001 values) to the Canadian health care perspective.CONCLUSIONS: The estimated cost savings associated with linezolid use not only offset the higher acquisition cost of the anti-infective, but may be substantial to health care systems across Canada, especially as the incidence of MRSA continues to rise.

Methicillin‐Resistant Staphylococcus aureus: A Public Health Issue with Economic Consequences

“…Controlling MRSA infection can be expensive and labour intensive, and can cause considerable disruption of clinical services (42). Several Canadian studies have investigated health care resource utilization and the direct medical costs associated with MRSA infection (22,(24)(25)(26)(27). Substantial variation was observed among studies in methodologies used and depth of analyses, as well as in their measures of health care utilization, resources included in estimates, cost per component and total cost per patient ( The cost of antimicrobial therapy was included in only two studies, and varied between $325 and $574 ( Table 2).…”

“…The present review indicated that Canadian patients infected with MRSA required prolonged hospitalization (average 26 days, range 14 to 36 days), comprising, on average, 81% of the total cost. Several studies have indicated that appropriate switching of MRSA patients from intravenous to oral treatment could reduce the length of hospital stay and cost per infected patient (26,41,45), suggesting that oral therapy may be one strategy to reduce the economic impact of MRSA. Cost estimates in the literature have varied from $7,222 to $14,630 per infected MRSA patient in Canada.…”

“…MRSA can be present in sputum, wounds and the bloodstream of infected patients, but also on apparently healthy skin, requiring extensive and costly barrier precautions to limit transmission (21). Several Canadian studies have explored resource utilization and costs associated with the management of MRSA patients (22)(23)(24)(25)(26)(27). In the early 2000s, the MRSA financial burden in Canada ranged from $40 to $59 million (22,24).…”

Cost Comparison of Linezolid Versus Vancomycin for Treatment of Complicated Skin and Skin‐Structure Infection Caused by Methicillin‐Resistant Staphylococcus aureus in Quebec

“…However, analyses of outcomes in a multinational trial of vancomycin versus linezolid in patients with cSSTIs due to MRSA showed that the length-of-stay and early-discharge advantages for linezolid differed according to country, due to regional variation in clinical practice (16), and no study has compared the total costs of cSSSI treatment with linezolid versus vancomycin in Canada based on established clinical practice. The only previous Canadian cost simulation suggesting linezolid could be cost saving relative to vancomycin for patients with SSTIs was based on extrapolations from chart review data in the period before the availability of linezolid in Canada (17). The objective of the present study was to evaluate the potential cost impact in Quebec of using IV and PO linezolid instead of IV vancomycin to treat cases of cSSSI caused by MRSA that are severe enough to require hospitalization, based on current treatment patterns in Quebec.…”

The Socioeconomic Impact of Musculoskeletal Infections

“…Rosner et al 87 reviewed the charts of all eighty-nine patients with methicillin-resistant Staphylococcus aureus infections admitted to a teaching hospital and treated with either intravenous administration of vancomycin or linezolid. The total hospital and nonhospital costs were higher in the vancomycin-treated group (Can$8444 per patient) compared with the linezolid-treated group ($7693 per patient), which had a one-day shorter length of stay with the patients discharged on oral linezolid.…”