Blanes, L

Chacón, A

Escudero, E

Flores, J

García, M

Hernández, F

Zaragoza, R

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PIN29 COST OF DIABETIC FOOT INFECTIONS DUE TO MRSA: AN ECONOMIC ANALYSIS OF DATA FROM PATIENTS TREATED WITH LINEZOLID IN SPAIN 

A422 Paris Abstracts
 economic beneﬁt between two different pneumococcal vaccines. Indirect costs were 
estimated for both vaccines according to the ﬁve approaches to assess the methodologi-
cal inﬂuence on the total disease cost difference between PCV-7 and PHiD-CV. Base-
line indirect cost estimates include the cost of productivity losses of paid workers due 
to disease, sequelae, and earlier death. Some of the approaches include in terms of 
cost: children’s future productivity losses, unpaid work loss and parents’ work loss, 
when looking after their sick children. RESULTS: Compared to FCM, HCM based 
approaches constantly generated higher estimates of indirect cost. Results of HCM 
ranged between a1.1bn (PHiD-CV), a1.2bn (PCV-7) and a1.9bn (both vaccines), while 
for FCM they ranged between a0.2bn and a0.9bna (both vaccines). Cost attributed 
to earlier death varied with a factor of 35; indirect cost due to earlier death as a pro-
portion of total indirect cost varied between 16% (conservative FCM) and 79% 
(conservative HCM). The overall impact on total disease cost differences between the 
two vaccines did not alter with any approach selected (PHiD-CV always dominates 
PCV-7), but the amount of savings signiﬁcantly differs depending on the used method. 
CONCLUSIONS: Although different approaches for estimating indirect cost have 
a huge impact on the cost difference between pneumococcal conjugate vaccines in  
Germany, the rating of these vaccines (PCV-7 dominated by PHiD-CV) stays unaf-          
fected. FCM always generates lower estimates than HCM.
PIN26
CLINICAL AND ECONOMIC IMPACTS OF BACTEREMIA CAUSED BY 
EXTENDED-SPECTRUM BETA–LACTAMASES PRODUCING 
ESCHERICHIA COLI IN HONG KONG
Mok SS, Chang CC, Ip M, You JH
The Chinese University of Hong Kong, Shatin, N.T, Hong Kong
OBJECTIVES: To evaluate the clinical and economic impact of bacteremia caused by 
extended-spectrum beta-lactamases (ESBL) producing Escherichia coli. METHODS: 
A case-control study was conducted in a teaching hospital in Hong Kong. Case 
patients who had blood cultures positive for ESBL-producing E. coli were matched 
with patients who had bacteremia caused by non-ESBL-producing E. coli from 
January 2002 through December 2004. Demographic data, clinical factors and health 
care resource utilization for bacteremia were retrieved from medical records. Outcome 
measurements included mortality, infection-related cost and infection-related length 
of stay. RESULTS: Thirty-ﬁve case patients with ESBL-producing E. coli bacteremia 
were matched with 35 control patients with non-ESBL-producing E. coli bacteremia. 
The mortality rates were 8/35 (22.9%) in cases and 1/35 (2.9%) in controls. The 
average total cost for cases and controls were HK$51,100 o $44,292 and HK$30,300 
o $19,427 (USD1  HKD7.8), respectively. Mean infection-related length of stay in 
cases was 11.5 o 4.9 days and 8.4 o 5.2 days in controls. Multiple regression analysis 
showed that ESBL production was not signiﬁcantly associated with mortality, but it 
was a signiﬁcant predictor of infection-related cost (ME: 1.32; 95% CI  1.04–1.69; 
P  0.001) and infection-related length of stay (ME:1.42, 95% CI  1.16–1.73, P  
0.001). CONCLUSIONS: ESBL-production was associated with increased length of 
stay and direct medical cost for treatment of E. coli bacteremia.
PIN27
COST-EFFECTIVENESS OF LINEZOLID VS. VANCOMYCIN AND 
TEICOPLANIN IN METHICILLIN-RESISTANT STAPHYLOCOCCUS 
AUREUS INFECTIONS IN CZECH REPUBLIC
Suchankova E1, Dolezal T2, Hájek P3, Kovár P3
1Charles University, Prague , Czech Republic, 2Charles University, Praha, Czech Republic, 
3Pﬁzer, Praha 5, Czech Republic
OBJECTIVES: Published clinical trials have shown similar clinical cure rates and 
shorter length of stay (LOS) for linezolid compared to vancomycin and teicoplanin in 
patients with methicillin-resistant Staphylococcus aureus (MRSA) infections. The aim 
of this pharmacoeconomic evaluation was to assess the cost-effectiveness of linezolid 
vs. vancomycin and teicoplanin from the perspective of Czech health care system. 
METHODS: We have collected the data on health care resource utilisation in patients 
with MRSA infections treated with linezolid, vancomycin or teicoplanin (drug admin-
istration, monitoring, hospitalisations, adverse events). Costs from ofﬁcial price lists 
of health insurance companies were applied to all colected items. Total costs of line-
zolid, vancomycin and teicoplanin treatment course were compared. We have analysed 
two subsets of patients—with MRSA infections after surgery hospitalized in ortho-
paedic clinic and patients with complicated MRSA infection requiring intensive care. 
RESULTS: Total number of 74 patients was analysed according to resource use and 
costs. The mean length of stay in MRSA patients in ortopaedic surgery patients was 
36.7 days and the mean hospitalisation cost was 94,462 CZK (a3,633). The mean 
length of stay in MRSA intesive care patients was 45.2 days and the mean hospitalisa-
tion cost was 204,775 CZK (a7876). There was a tendency for shorter length of hos-
pitalisation in the group of linezolid patiens in comparison to teicoplanin patients 
(32.7 vs. 43.6 days). The increased antibiotic acquisition cost of linezolid (three time 
higher in comparison with vancomycin and two times higher in comparison with tei-
coplanin) was balanced by the estimated cost savings for hospitalisations, and addi-
tional savings in laboratory monitoring, concomitant medication and adverse events. 
CONCLUSIONS: Based on the patient-speciﬁc data linezolid is cost-effective option 
for hospitalised MRSA patients in Czech Republic. Despite higher acquisition cost the 
total hospitalisation costs are very similar to teicoplanin and vancomycin.
PIN28
ECONOMIC ANALYSIS ABOUT VALGANCICLOVIR PROPHYLAXIS 
AGAINST INFECTION FROM CITOMEGALOVIRUS IN PATIENTS WITH 
RENAL TRANSPLANTATION
García-Tellez I1, Alberú J2, Sierra-Madero J3
1Roche México, Mexico D.F, Mexico, 2National Institute of Medical Sciences and Nutrition, 
México D.F., Mexico, 3National Institute of Medical Sciences and Nutrition, Mexico D.F., 
Mexico
OBJECTIVES: Compare the economic impact of prophylaxis with valganciclovir 
against cytomegalovirus (CMV) infection versus non-prophylactic decision, in renal 
transplantation recipients, for analysing cost of treatment. METHODS: Economic 
evaluation through a theoretical cost analysis to assess the impact of using prophylaxis 
with valganciclovir (450 mg every 12 h for 100 days) compared with no prophylaxis, 
in patients receiving a renal transplantation with high (D/R-) and intermediate (R) 
risk of CMV disease. Outcomes evaluated were secondary morbidity due to CMV 
infection, including organ rejection. Calculations about the referred complications 
were based on informed frequencies from medical literature. Costs were evaluated 
from the service provider perspective, in US dollars and include the resources used for 
prophylaxis and complications. Cost analysis results from the difference between 
symptomatic disease due to CMV, the cost of treating an acute rejection and the 
ﬁnancial pressure regarding both situations. The number of patients needed to treat 
(NPT) for achieving clinical success was calculated. RESULTS: Based on a hypotheti-
cal scenario of 1 thousand patients, equally distributed in each group, the frequency 
of symptomatic infection in the valganciclovir group would be 1% against to 31% in 
the non-prophylaxis group. The same tendency is kept regarding development of 
asymptomatic infection (4% vs. 32%) as well as organ rejection (1.5% vs 16.1%). 
CONCLUSIONS: With this theoretical pharmacoeconomic evaluation it is demon-
strated that the use of prophylaxis with valganciclovir might be a cost-saving alterna-
tive for a medium-term perspective, derived from reduction in the frequency of 
infections and indirect events related with CMV replication like organ rejection. In 
patients with intermediate risk (R), a comparison must be established between costs 
of prophylaxis and pre-emptive intervention, because the last might reduce medica-
tions consumption but increasing diagnosis and monitoring costs, as well as not 
avoiding indirect events related to viral replication.
PIN29
COST OF DIABETIC FOOT INFECTIONS DUE TO MRSA: AN ECONOMIC 
ANALYSIS OF DATA FROM PATIENTS TREATED WITH LINEZOLID  
IN SPAIN
Zaragoza R1, García M2, Blanes L3, Flores J4, Chacón A5, Hernández F6, Escudero E2
1Servicio de Medicina Intensiva, Hospital Universitario Dr. Peset, Valencia, Spain, 2Pﬁzer, 
Madrid, Spain, 3Servicio de Angiología y Cirugía Vascular. Hospital Universitario Dr. Peset, 
Valencia, Spain, 4Servicio Medicina Interna-UEI. Hospital Universitari Arnau de Vilanova, 
Valencia, Spain, 5Servicio de Cirugía Cardiovascular. Hospital Reina Sofía, Córdoba, Spain, 
6Biometrics, Euroclin Institute, Barcelona, Spain
OBJECTIVES: The aim of this study is to calculate direct cost of management diabetic 
foot infection (DFI) due to MRSA in diabetes mellitus (DM) patient-population treated 
with linezolid and to identify the most important factors related to treatment costs. 
METHODS: A cost-study was performed with data from 70 prospectively patients 
with DFI treated with linezolid from-2006-to-2008 in 10 Spanish Hospitals included 
in a non-comparative clinical trial. Cost for in-patient-stay, and outpatient manage-
ment were calculated retrospectively from diagnosis until healing or death in those 
patients where the cost data could be estimated. Cost for linezolid treatment (IV-oral), 
IV administration and monitoring were also estimated. Resource utilization not col-
lected during the study was based on published literature. Cost data derived from lit-
erature and Spanish database. Mean values for each item were used to calculate cost 
average. All costs are expressed in Euros 2007. RESULTS: Mean age was 63.2 years 
old (SD 13.0), being 68.1% males. Duration of DM was 16.5 years. A total of 55 
patients healed without amputation (78.6%) and 9 (12.9%) healed after amputation. 
Total cost for a patient without amputation was a9429.7 (95% CI 8404.2–10455.3), 
while corresponding cost for a patient with amputation was a9949.9 (95% CI 6034.3–
13865.6). Hospitalization accounts for 54% of cost of treating DFI in patients without 
amputation and 48% in patients with amputation. Surgery cost was 17% of total cost 
in patients undergoing amputation. Drug costs didn’t account for the major part of 
costs incurred during in-patient phase. Outpatient costs were 5% and 7% of total cost 
in patients without and with amputation, respectively. CONCLUSIONS: These are 
the ﬁrst cost data results for DFI due to MRSA in Spain. Amputations were associated 
with high cost mainly due to surgery and long-term cost. These ﬁndings suggest the 
potential efﬁciency of a targeted approach program to prevent amputations in patients 
with DFI.
PIN30
USE OF NET-BENEFIT REGRESSION FRAMEWORK TO INVESTIGATE 
THE COST-EFFECTIVENESS OF COMBINATION ANTIVIRAL THERAPY 
AMONG HCV-INFECTED PATIENTS ENROLLED IN A MANAGED CARE 
ORGANIZATION
Hsu CN, Kauf TL
University of Florida, Gainesville, FL, USA
OBJECTIVES: Whether combination antiviral therapy is cost-effective for patient with 
HCV in the real-world setting has not yet to be shown. This study is to compare the 
cost-effectiveness of combination antiviral therapy with no treatment in cirrhotic 
patients with q1 doses of combination prescriptions (base case), and with q48 weeks 


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PIN29 COST OF DIABETIC FOOT INFECTIONS DUE TO MRSA: AN ECONOMIC ANALYSIS OF DATA FROM PATIENTS TREATED WITH LINEZOLID IN SPAIN

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