Antibiotics for complicated skin and soft tissue infections - pharmacoeconomic analysis

September 19, 2016

Active substances:

Vancomycin

Linezolid

Tseftarolina fosamil

Tigecycline

Daptomycin

ICD-10:

XII.L00-L08.L08.9 Local infection of skin and subcutaneous tissue, unspecified

XIII.M70-M79.M79.9 Soft tissue disorder, unspecified

Antibiotics, staphylococcus, MRSA, resistant strains, telavancin, vancomycin, pharmacoeconomics, pharmacoeconomic analysis, pharmaco efficiency.

Staphylococcus aureus (S.aureus) is one of the main pathogens of skin and soft tissue infections, primarily nosocomial infections. Treatment of such infections is significantly complicated by the wide spread of strains of staphylococcus, resistant to oxacillin and methicillin (ORSA and MRSA). On the pharmaceutical market there are several drugs that are effective against the above-described resistant strains. All of them have a high price even by the standards of Western countries. In 2016 in Russia was first published pharmacoeconomic analysis of this group of drugs with an emphasis on telavancin.

For the treatment of infectious diseases caused by resistant strains of Staphylococcus aureus (ORSA and MRSA), several drugs are used, including:
- Vancomycin: an antibiotic from the group of tricyclic glycopeptides, isolated from the soil bacterium Amycolatopsis orientalis. The mechanism of action is associated with inhibition of the synthesis of the bacterial cell wall by binding to the dimer D-ala-D-ala.
- Telavancin: semisynthetic analogue of vancomycin, a similar mechanism of action.
- Linezolid: a synthetic antibiotic, a representative of the class of oxazolidinones. Linezolid binds to the 23S portion of the 50S subunit of the ribosome, preventing the initiation of protein synthesis.
- Tseftarolina fosamil: beta-lactam antibiotic, 5 th generation cephalosporin.
- Daptomycin: a lipopeptide antibiotic isolated from the bacterium Streptomyces roseosporus. The mechanism of action is a violation of the integrity of the cell membrane, which leads to ion leakage, rapid depolarization and death of the bacterial cell.
- Tigecycline: an antibiotic from the class of glycylcyclines (tetracycline derivatives). Linking to the 30S subunit of the ribosome, tigecycline prevents the binding of aminoacyl-tRNA to the A site of the ribosome, which leads to a violation of protein synthesis.
All the above drugs (except vancomycin) were released on the pharmaceutical market relatively recently and have a relatively high cost. Accordingly, a practicing physician faces a difficult task: to choose an antibacterial drug that is not only clinically effective, but also most appropriate from a financial point of view. This question is especially relevant for our country, because in most cases the drugs from the above list are purchased for budgetary funds.
To solve this problem in 2016, a comparative pharmacoeconomic analysis of antibacterial drugs used against resistant strains of S. aureus was conducted for the first time in the Russian market.
The study was conducted on the basis of three research institutes:
- First St. Petersburg State Medical University. acad. I.P. Pavlova
- St. Petersburg State University
- The Federal State Budgetary Institution "St. Petersburg Multidisciplinary Center"
The key authors of the analysis were Kolbin AS, Vilum IA, Proskurin MA, Balykina Yu.E.

	Telavancin	Vancomycin	Linezolid	Ceftaroline fosamyl	Daptomycin	Tigecycline
Tradename	Vibativ	Edicine	Zivox	Zinforo	Kubitsin	Tigacil
Frequency of clinical response	92 %	87 %	75 %	91 %	75 %	86 %
Exchange rate, rub.	143 733	17 313	61 339	78 627	46 406	83 879
Costs for inpatient care, rubles.	64 098*
Indirect costs**, rub.	17 656	28 912	54 513	18 980	55 175	30 015
Costs for treatment with ineffective therapy , rub.*	29 379	51 426	94 800	32 706	96 688	51 970
Costs for treatment of side effects, rub.	4 912	15 581	17 733	7 952	9 592	23 873
Total cost, rub.	259778	177330	292483	202363	271959	253835

Notes to the table:
* The cost of inpatient care is calculated at the appropriate rate of CSG ("Gangrene, phlegmon", cost - 64,098.00 rubles.).
** indirect costs include, for example, lengthening the length of hospitalization despite ongoing therapy.
*** Ineffective therapy - in this case a septic condition develops, requiring further therapy in the ICU and the appointment of combined antibacterial therapy, including Gram-positive and Gram-negative spectra. It was also assumed that the patient underwent surgery for the purpose of sanitizing the focus of infection under general anesthesia.

Note:Conclusions:
1) Telavancin shows the greatest clinical efficacy in the treatment of complicated infections of the skin and soft tissues.
2) Telavancin has the largest exchange value, but is the leader in the remaining pharmacoeconomic indicators.
3) The most profitable from a financial point of view is vancomycin, primarily due to the relatively low exchange rate.
4) According to the analysis, linezolid has the lowest clinical efficacy and is economically least expedient (high exchange value, as well as the maximum indirect costs and costs of treatment of side effects).

A source:

Kolbin AS, Vilum IA, Proskurin MA, Balykina Yu.E.Pharmacoeconomic analysis of the use of telavancin in the therapy of patients with complicated infections of the skin and soft tissues in public health conditions // Pharmacoeconomics: theory and practice. - 2016. - T.4, №2. - P.75-81