Clinical Effectiveness And Economy Between Patients With Pneumonia By The Use Of Vancomycin And Linezolid Injection: A Real World Data Analysis

Objectives:To analyze the clinical effectiveness and economy including all-cause health resources utilization and direct medical costs between patients with pneumonia clinically diagnosed and suspected Methicillin-resistant Staphylococcus aureus(MRSA)infection by use of vancomycin and linezolid injection,and to compare the differences of them between two therapies.Methods:Data were obtained from hospital information system(HIS)electronic archives data base of The Second Hospital of Tianjin Medical University from January,2012 to December,2016.Patients who were clinically diagnosed and suspected MRSA infection and accepted vancomycin and(or)linezolid treatment during study period were included.The clinical effectiveness,all-cause health resources utilization and direct medical costs were analyzed among patients accepted vancomycin and linezolid.The propensity score matching(PSM)was used to control the basic characteristics of the two subgroups processing bias,and the differences between the subgroups were compared by using t-tests and chi-square tests.Multiple linear regression models were used to evaluate the risk factors of all-cause length of stay and direct medical costs in hospitalization.Results: A total of 692 patients were identified,67 patients accepted vancomycin and linezolid meanwhile,227 patients accepted vancomycin and 398 patients accepted linezolid.After PSM,157 eligible patients were included in both groups respectively.Before PSM,patients in the group of linezolid were younger than vancomycin group(47.4±39.7 years vs.68.7±19.7 years,p<0.001),the proportion of insured patients were less than vancomycin group(47.1% vs.73.9%,p<0.001)while there were no statistical difference between two groups after PSM.The cure rates of linezolid group were higher than that those in vancomycin group before and after PSM(P<0.05),and there was no significant difference in mortality between the two groups before and after PSM.Before PSM,the all-cause length of stay in hospitalization in the group of linezolid were less than those in vancomycin group(25.0±25.3d vs.30.2±32.6d,P=0.039)while there were no statistical difference between them after PSM.The regression model revealed that patients who were older and without any insurance were associated with the length of stay in hospital.Before PSM,the all-cause total direct medical costs in the group of linezolid were less than those in vancomycin group(54729.5±64712.9 RMB vs.71973.5±83325.8 RMB,P=0.007)while there were no statistical difference between them after PSM.The proportion of drug costs exceeded 50% in both groups.The regression model revealed that patients who were older had more costs,patients with any insurance and with vancomycin,whose admission diagnosis was confirmed as pneumonia and pulmonary infection spentless.Conclusions:There is a higher cure rate of linezolid in treatment of pneumonia patients with diagnosed and suspected MRSA infection in the group of linezolid compared to those with vancomycin;there is no statistical difference between length of stay and direct medical costs between two groups;so,linezolid is a better choice for treatment of pneumonia patients.Older and uninsured patients had longer length stay in hospitalization and more costs.