Economic evaluation among Chinese patients with nosocomial pneumonia caused by methicillin-resistant staphylococcus aureus and treated with linezolid or vancomycin: a secondary,post-hoc analysis based on a Phase 4 clinical trial study

Objective:

To assess cost-effectiveness of linezolid vs vancomycin in treating nosocomial pneumonia caused by methicillin-resistant Staphylococcus aureus (MRSA-NP) in China and the impact of renal failure on healthcare resource utilization (HCRU) and costs.

Methods:

Cost-effectiveness analysis was conducted based on data from the ZEPHyR trial, with efficacy measured by treatment success and costs calculated from HCRU. Confidence intervals (CI) for cost, efficacy and incremental cost-effectiveness ratios (ICER) were calculated by non-parametric bootstrap. Chi-square test was used for renal failure rate and t-test for HCRU/cost comparisons. Impact of renal failure was assessed using regression model.

Results:

Data from 448 patients (1:1 linezolid:vancomycin) were analyzed. More patients treated with linezolid achieved success (55% [95% CI?=?48–62%]) than with vancomycin (45% [38–52%]). Treatment cost were ¥79,551 (95% CI?=?¥72,421–¥86,680) for linezolid vs ¥77,587 (¥70,656–¥84,519) for vancomycin in Beijing, ¥90,995 (¥82,598–¥99,393) vs ¥89,448 (¥81,295–¥97,601) in Guangzhou, ¥82,383 (¥74,956–¥89,810) vs ¥80,799 (¥73,545–¥88,054) in Nanjing and ¥59,413 (¥54,366–¥64,460) vs ¥57,804 (¥52,613–¥62,996) in Xi’an. Per successful treatment, the ICER of linezolid over vancomycin were ¥19,719

(?¥143,553 to ¥320,980) (Beijing), ¥15,532 (?¥185,411 to ¥349,693) (Guangzhou), ¥15,904 (?¥161,935 to ¥314,987) (Nanjing) and ¥16,145 (?¥100,738 to ¥234,412) (Xi’an). From simulations, the majority of linezolid cases had greater efficacy and higher costs and more than one third had greater efficacy and lower costs. More vancomycin patients developed renal failure (15% vs 4%, p?<?0.001). Patients with renal failure had higher cost (Nanjng: ¥100,449 (SD?=?¥65,080) vs ¥74,944 (SD?=?¥49,632), p?=?0.002).

Conclusion:

Linezolid was more cost-effective than vancomycin in treating MRSA-NP from a Chinese payer’s perspective, and associated with less renal failure, HCRU and cost.     

Costs of in-house genomic profiling and implications for economic evaluation: a case example of non-small cell lung cancer (NSCLC)

Abstract

Objectives

Genomic profiling in oncology is vital for determining eligible patients for mutation-specific targeted therapies. Use of commercial genomic testing has the potential to improve patient outcomes. Economic evaluations of in-house genomic profiling typically only include material costs while external commercial services include many other factors. Using non-small cell lung cancer (NSCLC) as an example, this study sought to characterize the unique challenges of costing testing services and their impact on results of economic evaluations.     

Questioning the empirical basis of the environmental Kuznets curve for CO2: New evidence from a panel stationarity test robust to multiple breaks and cross-dependence

This paper investigates the time series properties of per capita CO₂ emissions and per capita GDP levels for a sample of 86 countries over the period 1960-2000. For that purpose, we employ a state-of-the-art panel stationarity test which incorporates multiple shifts in level and slope, thereby controlling for cross-sectional dependence through bootstrap methods. Our analysis renders clear-cut evidence that per capita GDP levels are nonstationary for the world as a whole while per capita CO₂ is found to be regime-wise trend stationary. The analysis of country-groups shows that for Africa and Asia, per capita CO₂ is best described as nonstationary, while per capita GDP appears stationary around a broken trend. In addition, we find evidence of regime-wise trend stationarity in both variables for the country-groups consisting of America, Europe and Oceania. The results of our analysis carry important implications for the statistical modelling of the Environmental Kuznets curve for CO₂, since the differing order of integration in both variables for the world as a whole and for Africa and Asia calls into question the validity of panel cointegration techniques which assume that both variables are nonstationary and cointegrated with one another. Cointegration techniques would not be appropriate either for the case of America, Europe and Oceania which are characterised by per capita GDP and CO₂ emissions being stationary around a broken trend. Similar conclusions are reached when we analyse country-groups based on levels of development. Failure to properly characterise the time series properties of the data by not controlling for an unknown number of structural breaks and for cross-sectional dependence could be responsible for the fragility and lack of robustness surrounding the estimation of environmental Kuznets curves.