Cost-effectiveness analysis of linezolid versus vancomycin in the treatment of adult hospital-acquired and ventilator-associated methicillin-resistant staphylococcus Aureus Pneumonia (a systematic review).

Abstract

Background: Ventilator-Associated Pneumonia (VAP) is defined as pneumonia that occurs 48 to 72 h following endotracheal intubation and frequently involves pathogens demonstrating significant antibiotic resistance. Methicillin-Resistant Staphylococcus Aureus (MRSA) is the most common pathogen associated with pneumonia. The treatment of MRSA VAP is challenging and is associated with high rates of morbidity, mortality, and overall hospital costs. The selection of an appropriate therapeutic option serves to reduce mortality and overall healthcare expenses. Given the increasing emphasis on monitoring antibiotic consumption and the optimal utilization of limited resources, decision-makers are encouraged to employ economic evaluations to select a cost-effective treatment option and optimize outcomes based on available resources.

Objective: The main objective of this study is to identify and review the economic evaluations conducted regarding the treatment of MRSA VAP patients with linezolid, vancomycin, and teicoplanin, and to summarize the evidence and assess the methodologies employed.

Methods: This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The search strategy was initiated by formulating the PICOS question and based on the designed protocol, data were extracted from PubMed, Web of Science, Scopus, and Google Scholar databases up to June 8, 2025. The retrieved documents were limited to English and Persian languages. To maximize document retrieval, no restrictions were placed on the time frame or document type. Inclusion and exclusion criteria were applied for screening studies, and eligible studies were identified and their reporting quality was assessed with the CHEERS and Philips checklists.

Findings: The search yielded 1378 records, from which ten studies were ultimately utilized. Only three of ten studies were conducted within the MRSA VAP patient population, while the remaining were conducted within the patients with MRSA-related Hospital-Acquired Pneumonia (HAP). All ten included studies compared linezolid and vancomycin; teicoplanin was not discussed in any of the identified studies. Two studies also considered the duration of empirical antibiotic treatment. Nine studies were conducted using the cost-effectiveness method and one study using the cost-utility method. All studies utilized the decision tree analytical model. The majority of the studies have considered a short-term time horizon, and only two studies have utilized a lifetime horizon. All but one study assessed the robustness of their results through sensitivity analyses. The findings indicated that despite the high cost of the linezolid drug, its superior clinical efficacy, higher survival rates, and lower rates of adverse events and mortality make it cost-effective compared to vancomycin.

Conclusion: The results of the reviewed studies suggest that linezolid can be cost-effective compared to vancomycin in the treatment of the studied population. However, given the short-term time horizon and the limited costing perspective adopted by the studies, current clinical and economic realities, and each country's acceptable threshold for new treatments, we must be cautious in interpreting such findings.

Clinical trial: Not applicable.