pharmacoeconomic aspects for treatment of mrsa

PHARMACOECONOMIC

ASPECTS FOR ANALYSIS

OF TREATMENT ON

INFECTION FROM

METHICILLIN RESISTANT

STAPHYLOCOCCUS

AUREUS (MRSA)

M Sc Stevce Acevski

Macedonia

Pharmacoeconomic researches are identifying,

measuring and comparing costs and outcomes from

therapy in healthcare systems and in society

They are common criteria`s for making decision in health

policies

Nowadays all developed countries base their decision

making on various pharmacoeconomic analyses, in order to

make wise and fruitful decisions, regarding costs and

outcomes in the healthcare system

PHARMACOECONOMIC ASPECTS FOR ANALYSIS

OF TREATMENT ON INFECTION FROM

METHICILLIN RESISTANT STAPHYLOCOCCUS

AUREUS (MRSA)

Introduction

Bacterial infections from Methicillin resistant Staphylococcus aureus (MRSA) are serious epidemiological problem, as for hospital patients, and for patients treated in ambulatory *

The Agency for Healthcare Research & Quality (AHRQ) shows that MRSA is connected with 375 000 patients annually, of whom 23 000 died **

MRSA is one of the tree most common intra hospital infections




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Introduction - MRSA challenge

* Hornberg C, Knoop D, Kipp F., The importance of MRSA in patient care. Epidemiology, prevention and therapy. Orthopade 2006 Nov;

35(11):1159 - 60, 1162 - 4, 1166 - 7.

** Kavanagh K, Calderon L , Saman D and Abusalem S, The use of surveillance and preventative measures for methicillin-resistant

Staphylococcus aureus infections in surgical patients, Antimicrobial Resistance and Infection Control 2014, 3:18

Pharmacoeconomic evaluation of therapy of MRSA infections is difficult to make, but of excellence meaning for proper decision

According to fact that antibiotic resistance is growing, multi resistant species are identified on everyday basis, dealing with infections from MRSA is challenge

If we want to make analysis of the key factors in process for dealing with MRSA, then we should examine more perspectives, but precise clinical outcome of every individual should be made




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Introduction - MRSA challenge




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Perspectives

Positive Staphylococcus aureus culture

Not all positive culture Eg. 1/3 of all tested health workers with positive Staphylococcus aureus, of

which 2.58% MRSA – without symptoms*

Identify and diverse infected, from patients that have

positive bacterial identification Microbiology testing - time frame 24 - 48 h

Genom Era MRSA/SA test – homogenous PCR test – results in 50 min

* Mainous G et all. Nasal carriage of Staphylococcus aureus and Methicillin Resistant S. aureus

infections in surgical patients, Antimicrobial resistance and infection control 2014, 3:18




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When antibiotic?

When deciding which antibiotic treatment to start,

antibiotic`s choice is one way to reduce total financial

cost for the treatment

Protocols for specific infections, can give directions which

antibiotic to choose

Cost of the treatment




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Basic infection

Efficacy of the drug

Adverse reactions of the treatment

Compliance

Availability of health resources

Health insurance of the patient

Possibility of the patient to take care of himself

Costs connected with intravenous administration

Availability of/for PO therapy

Cost of therapeutic failure


Other factors:




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Cost factors in hospitalized patients

Direct costs


(cost pro doses or daily therapy costs)

Indirect costs

Cost for I.V. administration

Cost for follow up and evaluation of the patient

Cost for emerged antibiotic resistance and failure of the

treatment connected with antimicrobial resistance

Cost for adverse reactions from the therapy

Cost for therapeutic failure

(e.g. prolonged treatment or retreatment with other

antibiotic)

Cost for hospitalized patients

Use of antibiotics with longer shelf life (once or twice day

dosing)

Implementing “switch” principles

Empirically use of P.O. administered antibiotics for

hospitalized and ambulatory patients

Limited use of drugs that require plasmatic levels

Familiar with antimicrobial resistance

Tolerability of the drugs, low level of adverse reactions

Antimicrobial spectrum of the drug is essential for limiting

drug failures

Bioavailability of the drug, helps to prevent drug usage

without adequate tissue penetration

Cost reduction strategies




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“Switch” therapy




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Antimicrobial resistance

“Switch” principles




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“Switch” therapy – change from intravenous (IV) to per oral

(PO) rout of administration

“Switch” therapy - cuts the costs of the therapy without

influence on efficacy of the treatment * **

* Luna C., Vujacich P., Niederman M., Vay C., Gherardi C. Matera J., Jolly E., Impact of BAL data on

the therapy and outcome of Ventilator Associated Pneumonia., Chest March 1997, Vol 111. No. 3

**Cyriac JM., James E., Switch over from intravenous to oral therapy: A concise overview., J

Pharmacol Pharmacother 2014 Apr; 5(2):83-7





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Short course of intravenous treatment 2-3 days followed

with per oral treatment for the rest of the treatment, has a

multiple advantages for a lot of patients

Switch therapy is commonly used practice in the developed

countries


When

Factors when switch from IV to PO administration:

Afebrile for 8 to 12 hours

Stabilization of general condition and leading clinical symptoms

Normalizing white blood cells

Adequate oral intake and gastrointestinal absorption

Individual assessment of the patient




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Why

Benefits from switch:

Reduced risk of hospital infections

Reduced risk of complications

Shorter hospital stay

Reductions on hospital staff

Comfort and compliance




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Antimicrobial resistance




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Development of resistance - natural phenomenon

Increased use of antimicrobials - increased resistance

Reduction of use does not necessarily reduce resistance!!!

Cost of antimicrobial resistance




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All healthcare systems try to evaluate economic cost of

antimicrobial resistance, but treatment with antimicrobials

can lead from less than £5 to more than £20,000 *

Factors that currently estimate the cost of resistance are

modest, they are based loosely on the ‘incremental’ cost

related to the extra treatment of resistant over susceptible

primary infection *

* Smith RD; Coast, J., The economic burden of antimicrobial resistance: Why it is more serious

than current studies suggest. Technical Report. London School of Hygiene Tropical Medicine,

London 2012

Antimicrobial resistance factor in deciding




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When deciding which antibiotic treatment should be used for

treating MRSA infection, antimicrobial resistance should

be one of the factors in deciding

Knowledge of antimicrobial resistance can help make

proper antibiotic choice and lower risk of failure and

antibiotic misuse

Table 3. Differences in antimicrobial resistance at MRSA isolates in Hungary,

Austria and Macedonia

Hungary Austria Macedonia

MRSA isolates 158 40 72

Antibiotic

Vancomycin S S S

Amikacin S S > 70,8% R

Gentamycin 73,7 % R > 90% R > 90% R

Clindamycin R R R

Clarithromycin > 90% R > 90% R > 90% R

Ciprofloxacin > 90% R > 90% R > 90% R

Levofloxacin > 90% R > 90% R > 90% R

Moxifloxacin > 90% R > 90% R > 90% R

Shortcuts: S = Susceptible, I = Intermediate, R = Resistant

Horváth A., Malmos G., Pesti N., Kristóf K., Nagy K., Cekovska Z., Kotolácsi G., Gattringer R.,

Graninger W., Rozgonyi F., Differences in antibiotic resistance between MRSA and MSSA strains

isolated in Hungary, Austria and Macedonia, Abstract number: 1733_207, ESCMID 17th European

congress of clinical microbiology an infectious diseases, ICC, Munich, Germany, 2007

Antimicrobial resistance - situation




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Evaluate also




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Death rate (%)

Usual days of hospital stay

Hospitalization in ICU

Use of additional medical procedures

Prolonged hospital stay

Cost – efficacy of the therapy




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Cost efficacy of the antimicrobial treatment starts with the

initial therapy, after clinical evaluation of the patient and

start of antibiotic treatment

When treating there are possible interventions as: wound

cleaning, incision, drainage, antimicrobial testing, parenteral

therapy and hospitalization





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Every day clinical evaluation, results from microbiological

testing, can lead to additional treatment change of

antibiotic or switch to administration to per oral routes

Everyday evaluation, adverse effects and comorbidities

have influence in better cost efficacy ratio




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Conclusion 1/3

Main factor in evaluation of antimicrobial agents used in

treatment of MRSA infection is patient

Evaluation of economic factors is main step when

deciding and use of antimicrobial therapy

Factors that are evaluated are multiple, complex,

interconnected and changeable with time




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Conclusion 2/3

Make evaluation of the patient with possible infection

Start aggressive antibiotic treatment, in time adjust it

as you get clinical and laboratory data

Observe data for antimicrobial resistance, so you

could make proper antibiotic use




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Conclusion 3/3

Make continuously cost effectiveness evaluations so

you could follow costs for MRSA treatment




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Thank you for kind your attention

pharmacoeconomic aspects for treatment of mrsa

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