Nosocomial pneumonia caused by methicillin-resistant Staphylococcus aureus treated with linezolid or vancomycin: A secondary economic analysis of resource use from a Spanish perspective

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Viejo Moreno, J.Á. Sánchez-Izquierdo Riera, E. Molano Álvarez, J.A. Barea Mendoza, S. Temprano Vázquez, L. Díaz Castellano, J.C. Montejo González" "autores" => array:7 [ 0 => array:2 [ "nombre" => "R." "apellidos" => "Viejo Moreno" ] 1 => array:2 [ "nombre" => "J.Á." "apellidos" => "Sánchez-Izquierdo Riera" ] 2 => array:2 [ "nombre" => "E." "apellidos" => "Molano Álvarez" ] 3 => array:2 [ "nombre" => "J.A." "apellidos" => "Barea Mendoza" ] 4 => array:2 [ "nombre" => "S." "apellidos" => "Temprano Vázquez" ] 5 => array:2 [ "nombre" => "L." "apellidos" => "Díaz Castellano" ] 6 => array:2 [ "nombre" => "J.C." 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Latorre-Marco, M. Acevedo-Nuevo, M. Solís-Muñoz, L. Hernández-Sánchez, C. López-López, M.M. Sánchez-Sánchez, M. Wojtysiak-Wojcicka, J. de las Pozas-Abril, G. Robleda-Font, M.J. Frade-Mera, R. De Blas-García, C. Górgolas-Ortiz, J. De la Figuera-Bayón, C. Cavia-García" "autores" => array:14 [ 0 => array:2 [ "nombre" => "I." "apellidos" => "Latorre-Marco" ] 1 => array:2 [ "nombre" => "M." "apellidos" => "Acevedo-Nuevo" ] 2 => array:2 [ "nombre" => "M." "apellidos" => "Solís-Muñoz" ] 3 => array:2 [ "nombre" => "L." "apellidos" => "Hernández-Sánchez" ] 4 => array:2 [ "nombre" => "C." "apellidos" => "López-López" ] 5 => array:2 [ "nombre" => "M.M." "apellidos" => "Sánchez-Sánchez" ] 6 => array:2 [ "nombre" => "M." "apellidos" => "Wojtysiak-Wojcicka" ] 7 => array:2 [ "nombre" => "J." "apellidos" => "de las Pozas-Abril" ] 8 => array:2 [ "nombre" => "G." "apellidos" => "Robleda-Font" ] 9 => array:2 [ "nombre" => "M.J." "apellidos" => "Frade-Mera" ] 10 => array:2 [ "nombre" => "R." 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De Salas-Cansado, F. Mesa, C. Charbonneau, J. Chastre" "autores" => array:10 [ 0 => array:4 [ "nombre" => "J." "apellidos" => "Rello" "email" => array:1 [ 0 => "jrello@crips.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "M." "apellidos" => "Nieto" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "J." "apellidos" => "Solé-Violán" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "Y." "apellidos" => "Wan" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "d" "identificador" => "aff0020" ] ] ] 4 => array:3 [ "nombre" => "X." "apellidos" => "Gao" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "d" "identificador" => "aff0020" ] ] ] 5 => array:3 [ "nombre" => "C.T." 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Abbreviations: mITT, modified intent to treat." ] ] ] "textoCompleto" => "IntroductionMethicillin-resistant Staphylococcus aureus (MRSA) is a global problem and a common cause of pneumonia in hospitalized patients.<a class="elsevierStyleCrossRefs" href="#bib0140">1,2</a> Vancomycin is widely used for treating patients with serious MRSA infections, including hospital-acquired or healthcare-associated pneumonia.<a class="elsevierStyleCrossRef" href="#bib0150">3</a> Linezolid (oxazolidinone) is an alternative treatment option for nosocomial pneumonia (NP) caused by MRSA.<a class="elsevierStyleCrossRefs" href="#bib0150">3,4</a> Results from a recently completed phase 4, multicenter, double-blind, randomized clinical trial enrolling patients with MRSA NP<a class="elsevierStyleCrossRef" href="#bib0160">5</a> show that clinical success at end-of-study (EOS) is higher in patients treated with intravenous (IV) linezolid (57.6%) compared to dose-optimized IV vancomycin (46.6%; P=.042; per protocol population).<a class="elsevierStyleCrossRef" href="#bib0165">6</a>In Spain, more than 20% of invasive S. aureus isolates were resistant to methicillin in the year 2012. Results were similar in other European countries, with the majority reporting methicillin resistance in more than 10% and 11 countries reporting methicillin resistance in more than 20% of S. aureus isolates.<a class="elsevierStyleCrossRef" href="#bib0170">7</a> Results from the Extended Prevalence of Infection in the intensive care unit (ICU) (EPIC II) study suggest that MRSA prevalence is even higher in European Intensive Care Units. In this study, the most commonly isolated organism from European ICUs was S. aureus (20.5%) where 49.4% of S. aureus isolates were methicillin resistant.<a class="elsevierStyleCrossRef" href="#bib0175">8</a> Patients with infections caused by resistant compared to nonresistant bacteria have increased mortality, hospital length of stay (LOS), and healthcare costs.<a class="elsevierStyleCrossRef" href="#bib0180">9</a>To our knowledge, few studies have compared the economic outcomes associated with linezolid and vancomycin treatment in patients with MRSA NP from a Spanish perspective<a class="elsevierStyleCrossRef" href="#bib0260">10</a>. Additionally, information on the economic impact of renal failure from a Spanish perspective is lacking. To address this gap, we assessed healthcare resource use (HCRU) and costs, including costs incurred due to renal failure, for treating hospitalized adult MRSA NP patients with either linezolid or vancomycin from a Spanish perspective.MethodsThis is a secondary analysis of a randomized clinical trial of patients treated for nosocomial pneumonia with linezolid as compared to vancomycin.<a class="elsevierStyleCrossRef" href="#bib0165">6</a> While the analysis herein uniquely applies Spanish costs to this trial data, a similar economic study has been previously reported.<a class="elsevierStyleCrossRef" href="#bib0265">11</a> It is still unclear whether their conclusions apply to Spain, which has a different healthcare system and healthcare costing structure.Study cohortsThe study population is composed of patients from a randomized, double-blind, Phase IV global clinical trial, which compared the survival and treatment success rate in patients receiving linezolid vs. vancomycin for NP caused by MRSA.<a class="elsevierStyleCrossRef" href="#bib0165">6</a> The main analysis was performed among the modified intent-to-treat population (mITT), in which patients must have ≥1 doses of study treatments and a confirmed MRSA diagnosis based on a bacteria culture test. <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a> (patient flow chart) shows the cohort selection process starting from the intent-to-treat (ITT) cohort to the mITT cohort, and categorization of study comparison cohorts.<a class="elsevierStyleCrossRef" href="#bib0165">6</a> Detailed data about the study populations and study design of the clinical trial were published elsewhere.<a class="elsevierStyleCrossRef" href="#bib0165">6</a><elsevierMultimedia ident="fig0005"></elsevierMultimedia>In addition to the main analysis cohort of mITT patients, the subgroup of patients who developed renal failure during trial follow-up was also evaluated. The criteria for identifying this subgroup of patients included patients who developed acute renal failure defined using RIFLE criteria (Risk, Failure, Injury, Loss, and End-stage kidney disease), started renal replacement therapies (RRT) during follow-up and after the day of randomization, or developed an adverse event of renal failure reported by trial investigators.<a class="elsevierStyleCrossRef" href="#bib0270">12</a> Of note, this subgroup only included patients who developed renal failure during the trial period (until EOS) and after the day of randomization, and excluded patients receiving RRT on the day of randomization or prior to randomization.Economic variablesHCRUIn this clinical trial, hospital bed-days (including ICU stay, step-down, general ward and long term care), days of mechanical ventilation (MV), study treatment (vancomycin and linezolid) duration, vancomycin serum level monitoring, and RRT durations were collected from randomization until EOS.Costs from Spanish perspectiveFocusing on a Spanish perspective, unit costs (in 2012 Euros, <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>) were obtained from the Botplus-Portalfarma database<a class="elsevierStyleCrossRef" href="#bib0275">13</a> for the drugs, and the Oblikue database for other HCRU items (MV, hospital bed-day by type, vancomycin level monitoring and RRT).<a class="elsevierStyleCrossRef" href="#bib0280">14</a> Costs were calculated by multiplying the number or duration of each HCRU item with its corresponding unit cost. Total costs were broken down into cost components, including bed days, MV, study drug (plus drug monitoring costs), and RRT costs. The study was conducted from the perspective of the Spanish National Health System taking into account only direct medical economic costs.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>Statistical analysesEconomic outcomes were compared within the mITT cohort, and within the subgroup of patients who developed renal failure. To compare patients’ characteristics and economic outcomes between study groups, chi-squared tests (for categorical variables) and Student's t-tests (for continuous variables) were performed whenever appropriate. Fisher's exact tests were performed when ≥1cells had expected counts of <5. Additionally, Wilcoxon Signed-Rank tests were performed to compare the economic outcomes within the subgroup of patients who developed renal failure (as one comparison group had less than 30 patients).Within the mITT population, we compared costs/HCRU between patients who received linezolid vs. vancomycin, and between patients who developed renal failure and those who did not. Within the subgroup of patients who developed renal failure, economic outcomes were compared between treatment groups. Additionally, total costs per patient-day among those who developed renal failure were assessed between linezolid vs. vancomycin study groups.Adjusted for survival status at EOS, length of follow-up, and region, costs were examined between treatment groups, and patients who did and did not develop renal failure using generalized linear models with gamma distribution and log link.ResultsPatient cohortsThe primary analysis cohort (mITT) included 224 linezolid- and 224 vancomycin-treated patients (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Patients’ characteristics between linezolid- and vancomycin-treated patients are similar, including days from randomization till EOS. Exact details were reported in the prior US study.<a class="elsevierStyleCrossRef" href="#bib0265">11</a>A total of 43 patients developed renal failure during the trial, including 9 linezolid- and 34 vancomycin-treated patients (10% vs. 15%, P<.001; <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Of note, 3 out of the 405 patients who did not develop renal failure during the trial received RRT at or prior to randomization. As such, they were not included since their renal failure was prevalent rather than incident.Patients in the mITT population had a mean age of 61.8 years and were 65.6% male and 68.6% white. Except for comorbid renal impairment (58% vs. 28%, P<.001), sepsis/septic shock (30% vs. 12%, P<.001), and diabetes (56% vs. 40%, P=.04), the majority of demographic and clinical variables were similar between patients who developed renal failure and those who did not (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>Patients were followed for a mean duration of 23.3±10.1 days through the EOS. The follow-up duration from randomization until EOS was shorter for patients who developed renal failure (20.3±9.9 days) compared to those who did not (23.6±10.1 days, P=.04; <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). More patients also died at EOS among those who developed renal failure compared to those who did not (25% vs. 13%, P=.04; <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>), which could have contributed to the shorter follow-up duration. 39% of the mITT patients had not been discharged at their EOS visit. Among those patients, 56 were in ICU and 51 were on MV (41 were in both ICU and on MV).Healthcare resource use and costs from a Spanish perspectiveComparison by linezolid and vancomycin groups (mITT)No statistically significant differences in HCRU and total costs between the linezolid- and vancomycin-treated patients were identified. Patients who used MV (73% vs. 78%, P=.23), patients with ICU stay (86% vs. 89%; P=.32), mean duration of MV use (8.3±9.3 vs. 8.1±9.1 days; P=.84), mean ICU days (10.1±8.8 vs. 10.6±8.7 days, P=.58), and the mean hospital LOS (17.9±9.6 vs. 18.6±9.7 days, P=.45) were similar between the linezolid- and vancomycin-treated patients. The proportion of patients who received RRT (5 [2%] vs. 17 [8%] patients; P=.009), as well as mean RRT days per patient during the follow-up period (0.1±0.8 vs. 0.5±2.1 days; P=.02) differed significantly between the linezolid and vancomycin treatment groups, respectively.There was no statistically significant difference in total costs between study treatment groups within the mITT population (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). No significant differences were found in costs by department except for study drug costs, which were significantly higher for patients receiving linezolid compared to vancomycin therapy. After controlling for survival, duration of follow-up time, and region, patients randomized to linezolid had no significant difference in total costs as compared with vancomycin (cost ratio=1.05; P=.27).<elsevierMultimedia ident="fig0010"></elsevierMultimedia>Comparison by development of renal failure during trial (mITT)Mean MV (7.8±9.0 vs. 12.0±9.9; P=.004) and ICU days (10.0±8.5 vs. 13.5±9.9; P=.013) were significantly longer in patients who developed renal failure compared to those who did not. However, we did not find a significant difference in hospital LOS (18.2±9.6 vs. 18.8±9.8 days; P=.74). Please note that since 3 out of the 405 patients who did not develop renal failure had RRT at randomization, the mean RRT duration in this study group was not 0 (mean: 0.02) days.The costs of hospital bed-days (€18,333±€10,092 vs. €16,557±€9,061; P=.23), MV (€210±€172 vs. €135±€157; P=.004), and RRT (€678±€1,144 vs. €5±€69; P<.001) were significantly higher, drug costs were significantly lower (€405±€547 vs. €691±€593; P=.003), and total overall costs were numerically higher (€19,626±€10,840 vs. €17,388±€9,369; P=.14) among patients who developed renal failure compared to those who did not. Patients with renal failure had 19% higher costs after adjustment for survival, duration of follow-up time, and region (Cost ratio=1.19, P=.003).Comparison by linezolid and vancomycin groups (renal failure subgroup)No differences were found in clinical or demographic variables between patients who received linezolid (N=9) and vancomycin (N=34) within the subgroup of patients who developed renal failure (N=43). Although not statistically significant, the duration of MV (7.6±3.6 vs. 13.2±10.7 days; P=.21), ICU stay (9.9±6.6 vs. 14.4±10.5 days; P=.30), inpatient LOS (16.1±11.0 vs. 19.5±9.5 days; P=.26) and duration of RRT (1.9±3.6 vs. 2.9±4.8 days; P=.77) trended shorter for patients treated with linezolid compared to vancomycin.Compared to vancomycin (including vancomycin-level monitoring costs), linezolid drug costs were higher (€1,233±€590 vs. €186±€246, P<.001), while total medical costs (€17,219±€8,792 vs. €20,263±€11,350; P=.51) and total costs per patient-day (€1,000±€272 vs. €1,010±€312; P=.98) were numerically lower for linezolid vs. vancomycin patients within the subgroup of patients who developed renal failure. The difference in survival status at EOS between treatment groups was adjusted for by calculating economic cost per person-day.DiscussionThe current study highlights the economic burden associated with MRSA NP from a Spanish payer's perspective. The results showed that there were no significant differences in treatment costs for linezolid- (€17,782) and vancomycin-treated (€17,423) patients. Significantly higher drug cost for linezolid vs. vancomycin therapy may have been partially offset by fewer renal failure events. Bed costs were the main cost driver, of which ICU costs constituted the highest proportion.To the best of our knowledge, this is the largest study focusing on a Spanish payer's perspective that evaluates the economic burden of MRSA NP treatments using data from a randomized clinical trial. Prior studies have evaluated the treatment costs of linezolid vs. vancomycin in patients with MRSA NP from a US<a class="elsevierStyleCrossRef" href="#bib0265">11</a> and a China<a class="elsevierStyleCrossRef" href="#bib0285">15</a> perspective. At the outset of this analysis, it was unclear whether the conclusions from the prior US study would remain robust when the Spanish costs were applied, due to fundamental differences in each country's healthcare system. In Spain and most other European countries, healthcare is universally covered and fully funded from taxes obtained from the public sector. This means that health services are mostly free of charge at the point of delivery.<a class="elsevierStyleCrossRef" href="#bib0290">16</a> In contrast, healthcare in the US is not universally covered; no single payer for healthcare exists. China also has a different healthcare system compared to most of the western countries, adopting increasing health care privatization, and decentralization from the central government to provincial and local authorities.<a class="elsevierStyleCrossRef" href="#bib0295">17</a>Although the main conclusions of this study are consistent with the prior US economic analysis,11 there are some notable differences from the Spanish perspective. A key difference in the findings is that the total costs and cost components were lower from a Spanish payer's perspective compared to the US for both treatment groups, which is likely driven by the difference in unit costs. In a cross-national study comparing the US healthcare system with other Organization for Economic Cooperation and Development (OECD) countries, it was suggested that Americans have comparably fewer physician office visits and hospital days. However, the total medical expenditures in the US are twice as high per capita as most other OECD countries, including Spain.<a class="elsevierStyleCrossRef" href="#bib0300">18</a> This conclusion is consistent with our findings from the ZEPHyR trial that patients enrolled in European countries (10%) had over 40% longer LOS than the US (63%) (mean LOS: 23 vs. 16 days) but lower total hospitalization costs for both treatment groups. The incremental difference in total cost between the linezolid and vancomycin groups was the highest in our study (€359), followed by China (¥1,584=€222)<a class="elsevierStyleCrossRef" href="#bib0285">15</a> and US ($107=€102) studies<a class="elsevierStyleCrossRef" href="#bib0265">11</a>. As the incremental treatment success rate in linezolid vs. vancomycin is ∼10% (55% vs. 45%), the incremental cost per additional treatment success at base case may be the highest in the current study compared to studies in the US ($16,516 [95% CI: −$68,620 to $164,478]) and in China (¥15,904 [95% CI: −¥161,935 to ¥314,987]).<a class="elsevierStyleCrossRefs" href="#bib0265">11,15</a> More details about the comparison of the prior US, China and the current Spanish studies were provided in the <a class="elsevierStyleCrossRef" href="#sec0095">Supplemental table</a>.Several additional modeling studies also evaluated the economic impact of linezolid and vancomycin therapy for patients with MRSA NP from various perspectives in the US and European countries. León et al.<a class="elsevierStyleCrossRef" href="#bib0260">10</a> evaluated the incremental cost-effectiveness ratio of linezolid vs. vancomycin under a decision-analytical framework from a Spanish payer perspective. The study concluded that linezolid was cost-effective against vancomycin, with incremental cost/life-years gained and death avoided below the acceptable threshold.<a class="elsevierStyleCrossRef" href="#bib0260">10</a> Patel et al. published two studies evaluating the cost-effectiveness of linezolid vs. vancomycin from a US and German payer perspective.<a class="elsevierStyleCrossRefs" href="#bib0305">19,20</a> In Germany and the US, they suggested that the cost-effectiveness ratio favored linezolid over vancomycin as linezolid-treated patients had greater efficacy and cost-offset by lower treatment failure-related costs in Germany and US.<a class="elsevierStyleCrossRefs" href="#bib0305">19,20</a>Although some economic data can be gleaned from the literature, data on the economic burden associated with MRSA pneumonia are limited in Europe (especially in Spain) and varied widely across studies. Results from a Spanish study evaluating data from 27 hospitals found that MRSA bacteremia was associated with a mean inpatient LOS of 25 days, an ICU admission rate of 28.7%, and treatment costs of €11.884 per episode (updated to 2012 Euros).<a class="elsevierStyleCrossRef" href="#bib0250">21</a> A European study (EUVAP) concluded that patients who received inappropriate compared to appropriate empiric treatment had longer ICU stays by approximately 6 days.<a class="elsevierStyleCrossRef" href="#bib0255">22</a> Our study results provide updated economic data on treatments of vancomycin and linezolid for MRSA NP, emphasizing the importance of minimizing total medical costs and improving clinical outcomes through the use of appropriate antibiotics under the Spanish healthcare system and potentially that of other countries.It is important to understand this study's findings in the context of its limitations. First, the follow-up period for collecting HCRU items and cost calculation through EOS were limited in the study. Length of stay was likely underestimated since ∼40% of patients were hospitalized at the EOS visit and their discharge date was not captured. This is a limitation often observed in clinical studies. In most randomized clinical trials, HCRU data are not usually collected after the EOS visit and are usually truncated when the clinical evaluation ends. In our study, the proportion of patients who remained hospitalized at EOS was balanced between treatment groups, as was time to the EOS visit. Therefore, we would expect the effect on HCRU and cost differences between treatment groups to be minimal. In addition, the regression analysis adjusting for the difference in follow-up, survival, and region showed similar findings as in the descriptive analysis. Second, although we applied unit cost data from Spain to the study results, the results were obtained primarily from patients hospitalized in the US which explains why our LOS was shorter than that reported for other European populations. Given that the patients were randomly assigned into the treatment groups in each region, the difference in HCRU and costs between treatments may not be largely impacted by this limitation. Third, the vancomycin doses used in this clinical trial<a class="elsevierStyleCrossRef" href="#bib0165">6</a> may not reflect dosing patterns in real-world clinical practice since vancomycin dosing was optimized within the randomized clinical trial. Fourth, this analysis was conducted in the mITT population. Consequently, this datum does not represent the HCRU or costs of empiric treatment for patients at risk for MRSA. Lastly, it is likely that this study was underpowered to detect differences in continuous HCRU and cost outcomes between treatment groups, especially within the subgroup of patients who developed renal failure. Therefore, linezolid's benefits in the lower renal failure rate did not translate into a statistically significant difference in total medical cost when compared with vancomycin.Despite these limitations, our study results add evidence to demonstrate the importance of MRSA NP economic burden from a Spanish payer's perspective. This study provides valuable information by quantifying the economic impact associated with two antibiotic treatments in Spain. Decision makers may use this information to justify the need for strategies aimed at MRSA prevention, and clinicians may use this information to understand the economic burden associated with antibiotic treatment strategies.ConclusionFocusing on a Spanish perspective, our study provides updated data on the economic burden associated with linezolid and vancomycin treatment in patients with MRSA NP and the impact of renal failure on HCRU and costs. It was found that HCRU and costs were similar for linezolid- and vancomycin-treated patients with MRSA NP during the study period by applying Spanish unit cost data to HCRU data collected from an international randomized clinical trial. Linezolid's high drug acquisition costs were partially offset by fewer renal failure events which impacted ICU, hospital bed, and RRT costs. The potential consequences of developing renal failure include increased mortality and treatment costs. Future research is warranted to further explore the potential impact of linezolid and optimally-dosed vancomycin on HCRU, including the risk of renal adverse events, and the associated economic costs within the Spanish National Health System and other European countries.Authors’ contributionsDr. Jordi Rello, Dr. Jordi Solé-Violán, Dr. Mercedes Nieto, and Dr. Jean Chastre contributed to study conceptualization and design. Caitlyn T. Solem, Yin Wan, and Xin Gao developed the analysis plan and methodology, and performed the analysis. Marina de Salas-Cansado, Francisco Mesa, and Claudia Charbonneau contributed to study conceptualization and methodology development. All authors listed made substantial contributions to the study in conceptualization and/or study design, analysis and/or data interpretation and manuscript preparation and/or review. All authors read, edited, and approved the final manuscript.Conflicts of interestThis work was supported by Pfizer, Inc. Pharmerit International received consulting fees from Pfizer, Inc. in connection with this study and development of this manuscript. Caitlyn T. Solem, Yin Wan, and Xin Gao are employees of Pharmerit International. Dr. J Rello received an honorarium from Pfizer Inc. in connection with his work on this study and has been a consultant and an advisory board member and has received honoraria for advice or public speaking for Pfizer Inc. Dr. Mercedes Nieto received an honorarium from Pfizer, Inc. in connection with work on this study, has been a consultant and an advisory board member, and has received honoraria for advice or public speaking for Pfizer, Inc. Dr. Jordi Solé-Violán received an honorarium from Pfizer, Inc. in connection with work on this study, has been a consultant and an advisory board member, and has received honoraria for advice or public speaking for Pfizer, Inc. Jean Chastre received an honorarium from Pfizer, Inc. in connection with work on this study, has been a consultant and an advisory board member, and has received honoraria for advice or public speaking for Pfizer, Inc. Francisco Mesa and Claudie Charbonneau are employees and shareholders of Pfizer, Inc. Marina de Salas-Cansado is a former employee of Pfizer, Inc." "textoCompletoSecciones" => array:1 [ "secciones" => array:13 [ 0 => array:3 [ "identificador" => "xres752650" "titulo" => "Abstract" "secciones" => array:8 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Design" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Scope" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Participants" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Interventions" ] 5 => array:2 [ "identificador" => "abst0030" "titulo" => "Primary endpoints" ] 6 => array:2 [ "identificador" => "abst0035" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec755006" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres752649" "titulo" => "Resumen" "secciones" => array:8 [ 0 => array:2 [ "identificador" => "abst0045" "titulo" => "Objetivos" ] 1 => array:2 [ "identificador" => "abst0050" "titulo" => "Diseño" ] 2 => array:2 [ "identificador" => "abst0055" "titulo" => "Ámbito" ] 3 => array:2 [ "identificador" => "abst0060" "titulo" => "Participantes" ] 4 => array:2 [ "identificador" => "abst0065" "titulo" => "Intervenciones" ] 5 => array:2 [ "identificador" => "abst0070" "titulo" => "Principales variables de interés" ] 6 => array:2 [ "identificador" => "abst0075" "titulo" => "Resultados" ] 7 => array:2 [ "identificador" => "abst0080" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec755005" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Methods" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Study cohorts" ] 1 => array:3 [ "identificador" => "sec0020" "titulo" => "Economic variables" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0025" "titulo" => "HCRU" ] 1 => array:2 [ "identificador" => "sec0030" "titulo" => "Costs from Spanish perspective" ] ] ] 2 => array:2 [ "identificador" => "sec0035" "titulo" => "Statistical analyses" ] ] ] 6 => array:3 [ "identificador" => "sec0040" "titulo" => "Results" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0045" "titulo" => "Patient cohorts" ] 1 => array:3 [ "identificador" => "sec0050" "titulo" => "Healthcare resource use and costs from a Spanish perspective" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0055" "titulo" => "Comparison by linezolid and vancomycin groups (mITT)" ] 1 => array:2 [ "identificador" => "sec0060" "titulo" => "Comparison by development of renal failure during trial (mITT)" ] 2 => array:2 [ "identificador" => "sec0065" "titulo" => "Comparison by linezolid and vancomycin groups (renal failure subgroup)" ] ] ] ] ] 7 => array:2 [ "identificador" => "sec0070" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0075" "titulo" => "Conclusion" ] 9 => array:2 [ "identificador" => "sec0080" "titulo" => "Authors’ contributions" ] 10 => array:2 [ "identificador" => "sec0085" "titulo" => "Conflicts of interest" ] 11 => array:2 [ "identificador" => "xack250225" "titulo" => "Acknowledgments" ] 12 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2015-09-28" "fechaAceptado" => "2016-01-26" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec755006" "palabras" => array:5 [ 0 => "Methicillin-resistant Staphylococcus aureus" 1 => "Economics" 2 => "Renal failure" 3 => "Pneumonia" 4 => "Spain" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec755005" "palabras" => array:5 [ 0 => "Staphylococcus aureus resistente a meticilina" 1 => "Farmacoeconomía" 2 => "Insuficiencia renal" 3 => "Neumonía" 4 => "España" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "ObjectivesAdopting a unique Spanish perspective, this study aims to assess healthcare resource utilization (HCRU) and the costs of treating nosocomial pneumonia (NP) produced by methicillin-resistant Staphylococcus aureus (MRSA) in hospitalized adults using linezolid or vancomycin. An evaluation is also made of the renal failure rate and related economic outcomes between study groups. DesignAn economic post hoc evaluation of a randomized, double-blind, multicenter phase 4 study was carried out. ScopeNosocomial pneumonia due to MRSA in hospitalized adults. ParticipantsThe modified intent to treat (mITT) population comprised 224 linezolid- and 224 vancomycin-treated patients. InterventionsCosts and HCRU were evaluated between patients administered either linezolid or vancomycin, and between patients who developed renal failure and those who did not. Primary endpointsAnalysis of HCRU outcomes and costs. ResultsTotal costs were similar between the linezolid- (€17,782±€9,615) and vancomycin-treated patients (€17,423±€9,460) (P=.69). The renal failure rate was significantly lower in the linezolid-treated patients (4% vs. 15%; P<.001). The total costs tended to be higher in patients who developed renal failure (€19,626±€10,840 vs. €17,388±€9,369; P=.14). Among the patients who developed renal failure, HCRU (days on mechanical ventilation: 13.2±10.7 vs. 7.6±3.6 days; P=.21; ICU stay: 14.4±10.5 vs. 9.9±6.6 days; P=.30; hospital stay: 19.5±9.5 vs. 16.1±11.0 days; P=.26) and cost (€17,219±€8,792 vs. €20,263±€11,350; P=.51) tended to be lower in the linezolid- vs. vancomycin-treated patients. There were no statistically significant differences in costs per patient-day between cohorts after correcting for mortality (€1000 vs. €1,010; P=.98). ConclusionsFrom a Spanish perspective, there were no statistically significant differences in total costs between the linezolid and vancomycin pneumonia cohorts. The drug cost corresponding to linezolid was partially offset by fewer renal failure adverse events." "secciones" => array:8 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Design" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Scope" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Participants" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Interventions" ] 5 => array:2 [ "identificador" => "abst0030" "titulo" => "Primary endpoints" ] 6 => array:2 [ "identificador" => "abst0035" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "ObjetivosAnalizar la utilización de recursos sanitarios (URS) y los costes de la neumonía nosocomial por Staphylococcus aureus resistente a meticilina en adultos hospitalizados tratados con linezolid o vancomicina. También se evaluó el porcentaje de fallo renal entre dichos pacientes. DiseñoAnálisis post-hoc de un ensayo clínico fase iv multicéntrico, aleatorizado, doble ciego. ÁmbitoPacientes adultos, hospitalizados con neumonía nosocomial por Staphylococcus aureus resistente a meticilina. ParticipantesPacientes tratados con linezolid (224) o vancomicina (224). IntervencionesDesde la perspectiva española se compararon costes y URS entre pacientes tratados con linezolid o vancomicina y entre los que desarrollaron fallo renal y los que no. Principales variables de interésAnálisis de costes y URS. ResultadosLos costes totales fueron similares (p=0,69) en los pacientes tratados con linezolid (17.782±9.615€) o vancomicina (17.423±9.460€). La tasa de fallo renal fue significativamente menor en los tratados con linezolid (4 vs. 15%, p<0,001). Los costes totales fueron mayores en aquellos que desarrollaron fallo renal (19.626±10.840€ vs. 17.388±9.369€, p=0,14). La URS (días de ventilación mecánica: 13,2±10,7 vs. 7,6±3,6, p=0,21; días en UCI: 14,4±10,5 vs. 9,9±6,6, p=0,30; días de hospitalización: 19,5±9,5 vs. 16,1±11,0, p=0,26) y los costes totales (17.219±8.792€ vs. 20.263±11.350€, p=0,51) tendieron a ser inferiores en los pacientes tratados con linezolid que desarrollan fallo renal. Tras corregir el análisis por mortalidad, los costes diarios por paciente fueron similares (1.000 vs. 1.010€; p=0,98). ConclusionesDesde la perspectiva española, no hubo diferencias en la URS y los costes entre los pacientes con neumonía tratados con linezolid o vancomicina. El coste de linezolid fue contrarrestado por la menor incidencia de fallo renal." "secciones" => array:8 [ 0 => array:2 [ "identificador" => "abst0045" "titulo" => "Objetivos" ] 1 => array:2 [ "identificador" => "abst0050" "titulo" => "Diseño" ] 2 => array:2 [ "identificador" => "abst0055" "titulo" => "Ámbito" ] 3 => array:2 [ "identificador" => "abst0060" "titulo" => "Participantes" ] 4 => array:2 [ "identificador" => "abst0065" "titulo" => "Intervenciones" ] 5 => array:2 [ "identificador" => "abst0070" "titulo" => "Principales variables de interés" ] 6 => array:2 [ "identificador" => "abst0075" "titulo" => "Resultados" ] 7 => array:2 [ "identificador" => "abst0080" "titulo" => "Conclusiones" ] ] ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "The following are the supplementary data to this article:<elsevierMultimedia ident="upi0005"></elsevierMultimedia>" "etiqueta" => "Appendix A" "titulo" => "Supplementary data" "identificador" => "sec0100" ] ] ] ] "multimedia" => array:5 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1369 "Ancho" => 2277 "Tamanyo" => 186673 ] ] "descripcion" => array:1 [ "en" => "Patient flow chart. Abbreviations: mITT, modified intent to treat." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1314 "Ancho" => 2307 "Tamanyo" => 157191 ] ] "descripcion" => array:1 [ "en" => "Total costs (by component) per patient by treatment group (mITT population). Note: Costs are given in 2012 Euros. The study drug cost for vancomycin group includes the cost of drug and cost for testing the vancomycin levels. Abbreviations: MV, mechanical ventilation; mITT, modified intent to treat; RRT, renal replacement therapy." ] ] 2 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "Abbreviations: HD: hemodialysis; HF: hemofiltration; LTC: long-term care; ICU: intensive care unit; CRRT: continuous renal replacement therapy; IRRT: intermittent renal replacement therapy." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">HCRU item \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Description \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Unit cost (€)<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Unit \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Source \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top">Study medications</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Linezolid \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Linezolid IV (600mg per dose) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">59.61 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Per 600mg vial \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Botplus-Portalfarma<a class="elsevierStyleCrossRef" href="#bib0265">11</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Vancomycin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Vancomycin IV 15mg/kg per dose \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.90 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Per 1000mg vial \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Botplus-Portalfarma<a class="elsevierStyleCrossRef" href="#bib0265">11</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Vancomycin level \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Laboratory test for monitoring vancomycin levels \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14.55 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Per level \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Oblikue database<a class="elsevierStyleCrossRef" href="#bib0270">12</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top">Bed cost</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">ICU \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Intensive care unit \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1127.25 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Per day \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Oblikue database<a class="elsevierStyleCrossRef" href="#bib0270">12</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Step down \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Step down \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">851.35 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Per day \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Oblikue database<a class="elsevierStyleCrossRef" href="#bib0270">12</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">General ward \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">General ward \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">575.46 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Per day \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Oblikue database<a class="elsevierStyleCrossRef" href="#bib0270">12</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">LTC \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Nursing home/LTC \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">156.15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Per day \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Oblikue database<a class="elsevierStyleCrossRef" href="#bib0270">12</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Rehabilitation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Rehabilitation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">488.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Per day \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Oblikue database<a class="elsevierStyleCrossRef" href="#bib0270">12</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top">Others</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mechanical ventilator \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Mechanical ventilator \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Per day \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Oblikue database<a class="elsevierStyleCrossRef" href="#bib0270">12</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hemofiltration \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">CRRT – hemofiltration \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">253.59 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Per HF day \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Oblikue database<a class="elsevierStyleCrossRef" href="#bib0270">12</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hemodialysis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">IRRT – hemodialysis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">184.88 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Per HD day \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Oblikue database<a class="elsevierStyleCrossRef" href="#bib0270">12</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1245688.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "Costs presented are in 2012 Euros (€)." ] ] ] "descripcion" => array:1 [ "en" => "Spanish unit costs<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a>." ] ] 3 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "Abbreviations: APACHE, Acute Physiology and Chronic Health Evaluation; EOS, end of study; HCRU, healthcare resource utilization; ICU, intensive care unit; mITT, modified-intent to treat; SD, standard deviation." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variables \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Non-Renal Failure (N=405) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Renal Failure (N=43) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">P-value \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top">Demographic variables</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age, mean (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">61.6±18.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">64.1±16.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.38 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Median (range) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">66 (18, 98) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">69 (24, 86) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Male, No. (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">266 (66%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">28 (65%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.94 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Region, No. (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.29 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">United States \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">261 (64%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22 (51%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Asia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">49 (12%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 (19%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Europe \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">40 (10%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 (9%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Latin America \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">38 (9%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 (16%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Other \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17 (4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top">Follow-up characteristics</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Length since randomization until EOS in days, mean (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">23.6 (10.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20.3 (9.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.04 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Patients in hospital at the EOS visit, No. (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">159 (39%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16 (37%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.79 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Patients died at EOS, No. (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">53 (13%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11 (25%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.04 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top">Clinical variables</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top">Co-morbidities, No. (%)<a class="elsevierStyleCrossRef" href="#tblfn0015">b</a></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Atrial fibrillation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">89 (22%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 (28%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.39 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Chronic obstructive pulmonary disease (COPD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">119 (30%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 (16%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.07 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Diabetes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">159 (40%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24 (56%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.04 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Peripheral vascular disorder (PVD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">51 (13%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 (12%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.84 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hyperlipidaemia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">109 (27%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 (30%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.66 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hypertension \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">270 (67%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27 (63%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.56 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Renal impairment \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">113 (28%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25 (58%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Sepsis/Septic shock \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">48 (12%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 (30%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">APACHE II score at baseline, mean (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17.3 (6.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18.8 (6.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.12 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Baseline Clinical Pulmonary Infection Score, mean (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9.4 (2.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9.8 (2.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.37 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Baseline ventilated, No. (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">255 (63%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">31 (72%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.24 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">In ICU at or prior to randomization, No. (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">189 (84%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">197 (88%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.27 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1245687.png" ] ] ] "notaPie" => array:2 [ 0 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "a" "nota" => "Three patients in the non-renal failure group were receiving RRT during the baseline period and hence were not included in the developed renal failure group (due to prevalent evidence of renal impairment)." ] 1 => array:3 [ "identificador" => "tblfn0015" "etiqueta" => "b" "nota" => "Cardiac, kidney, pulmonary, and diabetes comorbidities present in ≥10% of patients in the total mITT population." ] ] ] "descripcion" => array:1 [ "en" => "Patient characteristics between patients who developed renal failure and those who did not<a class="elsevierStyleCrossRef" href="#tblfn0010">a</a>." ] ] 4 => array:5 [ "identificador" => "upi0005" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:2 [ "fichero" => "mmc1.docx" "ficheroTamanyo" => 32472 ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:22 [ 0 => array:3 [ "identificador" => "bib0140" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Microbial etiologies of hospital-acquired bacterial pneumonia and ventilator-associated bacterial pneumonia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "R.N. 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Li from Pfizer, Inc., and Professor Ben van Hout from the University of Sheffield." "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/21735727/0000004000000008/v1_201611050100/S217357271630056X/v1_201611050100/en/main.assets" "Apartado" => null "PDF" => "https://static.elsevier.es/multimedia/21735727/0000004000000008/v1_201611050100/S217357271630056X/v1_201611050100/en/main.pdf?idApp=WMIE&text.app=https://medintensiva.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S217357271630056X?idApp=WMIE"]

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Nosocomial pneumonia caused by methicillin-resistant Staphylococcus aureus treated with linezolid or vancomycin: A secondary economic analysis of resource use from a Spanish perspective

Neumonía nosocomial causada por Staphylococcus aureus resistente a meticilina tratada con linezolid o vancomicina: análisis económico secundario del uso de recursos sanitarios desde una perspectiva española

J. Relloa,

Corresponding author

jrello@crips.es

Corresponding author.

, M. Nietob, J. Solé-Violánc, Y. Wand, X. Gaod, C.T. Solemd, M. De Salas-Cansadoe, F. Mesae, C. Charbonneauf, J. Chastreg

a CIBERES, Universitat Autónoma de Barcelona, Spain

b Medicina Intensiva, Hospital Clínico Universitario de San Carlos, Madrid, Spain

c Medicina Intensiva, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de GC, Spain

d Pharmerit International, Bethesda, MA, United States

e Pfizer, Madrid, Spain

f Pfizer, Paris, France

g Service de Réanimation Médicale, Institut de Cardiologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France

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        "titulo" => "Neumon&#237;a nosocomial causada por <span class="elsevierStyleItalic">Staphylococcus aureus</span> resistente a meticilina tratada con linezolid o vancomicina&#58; an&#225;lisis econ&#243;mico secundario del uso de recursos sanitarios desde una perspectiva espa&#241;ola"
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          "en" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Patient flow chart&#46; <span class="elsevierStyleItalic">Abbreviations</span>&#58; mITT&#44; modified intent to treat&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Methicillin-resistant <span class="elsevierStyleItalic">Staphylococcus aureus</span> &#40;MRSA&#41; is a global problem and a common cause of pneumonia in hospitalized patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">1&#44;2</span></a> Vancomycin is widely used for treating patients with serious MRSA infections&#44; including hospital-acquired or healthcare-associated pneumonia&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">3</span></a> Linezolid &#40;oxazolidinone&#41; is an alternative treatment option for nosocomial pneumonia &#40;NP&#41; caused by MRSA&#46;<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">3&#44;4</span></a> Results from a recently completed phase 4&#44; multicenter&#44; double-blind&#44; randomized clinical trial enrolling patients with MRSA NP<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">5</span></a> show that clinical success at end-of-study &#40;EOS&#41; is higher in patients treated with intravenous &#40;IV&#41; linezolid &#40;57&#46;6&#37;&#41; compared to dose-optimized IV vancomycin &#40;46&#46;6&#37;&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;042&#59; per protocol population&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">6</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">In Spain&#44; more than 20&#37; of invasive <span class="elsevierStyleItalic">S&#46; aureus</span> isolates were resistant to methicillin in the year 2012&#46; Results were similar in other European countries&#44; with the majority reporting methicillin resistance in more than 10&#37; and 11 countries reporting methicillin resistance in more than 20&#37; of <span class="elsevierStyleItalic">S&#46; aureus</span> isolates&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">7</span></a> Results from the Extended Prevalence of Infection in the intensive care unit &#40;ICU&#41; &#40;EPIC II&#41; study suggest that MRSA prevalence is even higher in European Intensive Care Units&#46; In this study&#44; the most commonly isolated organism from European ICUs was <span class="elsevierStyleItalic">S&#46; aureus</span> &#40;20&#46;5&#37;&#41; where 49&#46;4&#37; of <span class="elsevierStyleItalic">S&#46; aureus</span> isolates were methicillin resistant&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">8</span></a> Patients with infections caused by resistant compared to nonresistant bacteria have increased mortality&#44; hospital length of stay &#40;LOS&#41;&#44; and healthcare costs&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">9</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">To our knowledge&#44; few studies have compared the economic outcomes associated with linezolid and vancomycin treatment in patients with MRSA NP from a Spanish perspective<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">10</span></a>&#46; Additionally&#44; information on the economic impact of renal failure from a Spanish perspective is lacking&#46; To address this gap&#44; we assessed healthcare resource use &#40;HCRU&#41; and costs&#44; including costs incurred due to renal failure&#44; for treating hospitalized adult MRSA NP patients with either linezolid or vancomycin from a Spanish perspective&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">This is a secondary analysis of a randomized clinical trial of patients treated for nosocomial pneumonia with linezolid as compared to vancomycin&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">6</span></a> While the analysis herein uniquely applies Spanish costs to this trial data&#44; a similar economic study has been previously reported&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">11</span></a> It is still unclear whether their conclusions apply to Spain&#44; which has a different healthcare system and healthcare costing structure&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Study cohorts</span><p id="par0025" class="elsevierStylePara elsevierViewall">The study population is composed of patients from a randomized&#44; double-blind&#44; Phase IV global clinical trial&#44; which compared the survival and treatment success rate in patients receiving linezolid vs&#46; vancomycin for NP caused by MRSA&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">6</span></a> The main analysis was performed among the modified intent-to-treat population &#40;mITT&#41;&#44; in which patients must have &#8805;1 doses of study treatments and a confirmed MRSA diagnosis based on a bacteria culture test&#46; <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a> &#40;patient flow chart&#41; shows the cohort selection process starting from the intent-to-treat &#40;ITT&#41; cohort to the mITT cohort&#44; and categorization of study comparison cohorts&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">6</span></a> Detailed data about the study populations and study design of the clinical trial were published elsewhere&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">6</span></a></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">In addition to the main analysis cohort of mITT patients&#44; the subgroup of patients who developed renal failure during trial follow-up was also evaluated&#46; The criteria for identifying this subgroup of patients included patients who developed acute renal failure defined using RIFLE criteria &#40;Risk&#44; Failure&#44; Injury&#44; Loss&#44; and End-stage kidney disease&#41;&#44; started renal replacement therapies &#40;RRT&#41; during follow-up and after the day of randomization&#44; or developed an adverse event of renal failure reported by trial investigators&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">12</span></a> Of note&#44; this subgroup only included patients who developed renal failure during the trial period &#40;until EOS&#41; and after the day of randomization&#44; and excluded patients receiving RRT on the day of randomization or prior to randomization&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Economic variables</span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">HCRU</span><p id="par0035" class="elsevierStylePara elsevierViewall">In this clinical trial&#44; hospital bed-days &#40;including ICU stay&#44; step-down&#44; general ward and long term care&#41;&#44; days of mechanical ventilation &#40;MV&#41;&#44; study treatment &#40;vancomycin and linezolid&#41; duration&#44; vancomycin serum level monitoring&#44; and RRT durations were collected from randomization until EOS&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Costs from Spanish perspective</span><p id="par0040" class="elsevierStylePara elsevierViewall">Focusing on a Spanish perspective&#44; unit costs &#40;in 2012 Euros&#44; <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41; were obtained from the Botplus-Portalfarma database<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">13</span></a> for the drugs&#44; and the Oblikue database for other HCRU items &#40;MV&#44; hospital bed-day by type&#44; vancomycin level monitoring and RRT&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">14</span></a> Costs were calculated by multiplying the number or duration of each HCRU item with its corresponding unit cost&#46; Total costs were broken down into cost components&#44; including bed days&#44; MV&#44; study drug &#40;plus drug monitoring costs&#41;&#44; and RRT costs&#46; The study was conducted from the perspective of the Spanish National Health System taking into account only direct medical economic costs&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Statistical analyses</span><p id="par0045" class="elsevierStylePara elsevierViewall">Economic outcomes were compared within the mITT cohort&#44; and within the subgroup of patients who developed renal failure&#46; To compare patients&#8217; characteristics and economic outcomes between study groups&#44; chi-squared tests &#40;for categorical variables&#41; and Student&#39;s <span class="elsevierStyleItalic">t</span>-tests &#40;for continuous variables&#41; were performed whenever appropriate&#46; Fisher&#39;s exact tests were performed when &#8805;1<span class="elsevierStyleHsp" style=""></span>cells had expected counts of &#60;5&#46; Additionally&#44; Wilcoxon Signed-Rank tests were performed to compare the economic outcomes within the subgroup of patients who developed renal failure &#40;as one comparison group had less than 30 patients&#41;&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Within the mITT population&#44; we compared costs&#47;HCRU between patients who received linezolid vs&#46; vancomycin&#44; and between patients who developed renal failure and those who did not&#46; Within the subgroup of patients who developed renal failure&#44; economic outcomes were compared between treatment groups&#46; Additionally&#44; total costs per patient-day among those who developed renal failure were assessed between linezolid vs&#46; vancomycin study groups&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Adjusted for survival status at EOS&#44; length of follow-up&#44; and region&#44; costs were examined between treatment groups&#44; and patients who did and did not develop renal failure using generalized linear models with gamma distribution and log link&#46;</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Results</span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Patient cohorts</span><p id="par0060" class="elsevierStylePara elsevierViewall">The primary analysis cohort &#40;mITT&#41; included 224 linezolid- and 224 vancomycin-treated patients &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Patients&#8217; characteristics between linezolid- and vancomycin-treated patients are similar&#44; including days from randomization till EOS&#46; Exact details were reported in the prior US study&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">11</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">A total of 43 patients developed renal failure during the trial&#44; including 9 linezolid- and 34 vancomycin-treated patients &#40;10&#37; vs&#46; 15&#37;&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#59; <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Of note&#44; 3 out of the 405 patients who did not develop renal failure during the trial received RRT at or prior to randomization&#46; As such&#44; they were not included since their renal failure was prevalent rather than incident&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Patients in the mITT population had a mean age of 61&#46;8 years and were 65&#46;6&#37; male and 68&#46;6&#37; white&#46; Except for comorbid renal impairment &#40;58&#37; vs&#46; 28&#37;&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#44; sepsis&#47;septic shock &#40;30&#37; vs&#46; 12&#37;&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#44; and diabetes &#40;56&#37; vs&#46; 40&#37;&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;04&#41;&#44; the majority of demographic and clinical variables were similar between patients who developed renal failure and those who did not &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">Patients were followed for a mean duration of 23&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#46;1 days through the EOS&#46; The follow-up duration from randomization until EOS was shorter for patients who developed renal failure &#40;20&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;9 days&#41; compared to those who did not &#40;23&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#46;1 days&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;04&#59; <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; More patients also died at EOS among those who developed renal failure compared to those who did not &#40;25&#37; vs&#46; 13&#37;&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;04&#59; <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#44; which could have contributed to the shorter follow-up duration&#46; 39&#37; of the mITT patients had not been discharged at their EOS visit&#46; Among those patients&#44; 56 were in ICU and 51 were on MV &#40;41 were in both ICU and on MV&#41;&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Healthcare resource use and costs from a Spanish perspective</span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Comparison by linezolid and vancomycin groups &#40;mITT&#41;</span><p id="par0080" class="elsevierStylePara elsevierViewall">No statistically significant differences in HCRU and total costs between the linezolid- and vancomycin-treated patients were identified&#46; Patients who used MV &#40;73&#37; vs&#46; 78&#37;&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;23&#41;&#44; patients with ICU stay &#40;86&#37; vs&#46; 89&#37;&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;32&#41;&#44; mean duration of MV use &#40;8&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;3 vs&#46; 8&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;1 days&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;84&#41;&#44; mean ICU days &#40;10&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;8 vs&#46; 10&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;7 days&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;58&#41;&#44; and the mean hospital LOS &#40;17&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;6 vs&#46; 18&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;7 days&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;45&#41; were similar between the linezolid- and vancomycin-treated patients&#46; The proportion of patients who received RRT &#40;5 &#91;2&#37;&#93; vs&#46; 17 &#91;8&#37;&#93; patients&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;009&#41;&#44; as well as mean RRT days per patient during the follow-up period &#40;0&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;8 vs&#46; 0&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;1 days&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;02&#41; differed significantly between the linezolid and vancomycin treatment groups&#44; respectively&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">There was no statistically significant difference in total costs between study treatment groups within the mITT population &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; No significant differences were found in costs by department except for study drug costs&#44; which were significantly higher for patients receiving linezolid compared to vancomycin therapy&#46; After controlling for survival&#44; duration of follow-up time&#44; and region&#44; patients randomized to linezolid had no significant difference in total costs as compared with vancomycin &#40;cost ratio<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;05&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;27&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0160">Comparison by development of renal failure during trial &#40;mITT&#41;</span><p id="par0090" class="elsevierStylePara elsevierViewall">Mean MV &#40;7&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;0 vs&#46; 12&#46;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;9&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;004&#41; and ICU days &#40;10&#46;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;5 vs&#46; 13&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;9&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;013&#41; were significantly longer in patients who developed renal failure compared to those who did not&#46; However&#44; we did not find a significant difference in hospital LOS &#40;18&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;6 vs&#46; 18&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;8 days&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;74&#41;&#46; Please note that since 3 out of the 405 patients who did not develop renal failure had RRT at randomization&#44; the mean RRT duration in this study group was not 0 &#40;mean&#58; 0&#46;02&#41; days&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">The costs of hospital bed-days &#40;&#8364;18&#44;333<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>&#8364;10&#44;092 vs&#46; &#8364;16&#44;557<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>&#8364;9&#44;061&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;23&#41;&#44; MV &#40;&#8364;210<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>&#8364;172 vs&#46; &#8364;135<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>&#8364;157&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;004&#41;&#44; and RRT &#40;&#8364;678<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>&#8364;1&#44;144 vs&#46; &#8364;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>&#8364;69&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41; were significantly higher&#44; drug costs were significantly lower &#40;&#8364;405<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>&#8364;547 vs&#46; &#8364;691<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>&#8364;593&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;003&#41;&#44; and total overall costs were numerically higher &#40;&#8364;19&#44;626<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>&#8364;10&#44;840 vs&#46; &#8364;17&#44;388<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>&#8364;9&#44;369&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;14&#41; among patients who developed renal failure compared to those who did not&#46; Patients with renal failure had 19&#37; higher costs after adjustment for survival&#44; duration of follow-up time&#44; and region &#40;Cost ratio<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;19&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;003&#41;&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0165">Comparison by linezolid and vancomycin groups &#40;renal failure subgroup&#41;</span><p id="par0100" class="elsevierStylePara elsevierViewall">No differences were found in clinical or demographic variables between patients who received linezolid &#40;<span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>9&#41; and vancomycin &#40;<span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>34&#41; within the subgroup of patients who developed renal failure &#40;<span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>43&#41;&#46; Although not statistically significant&#44; the duration of MV &#40;7&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;6 vs&#46; 13&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#46;7 days&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;21&#41;&#44; ICU stay &#40;9&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#46;6 vs&#46; 14&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#46;5 days&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;30&#41;&#44; inpatient LOS &#40;16&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#46;0 vs&#46; 19&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;5 days&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;26&#41; and duration of RRT &#40;1&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;6 vs&#46; 2&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;8 days&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;77&#41; trended shorter for patients treated with linezolid compared to vancomycin&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Compared to vancomycin &#40;including vancomycin-level monitoring costs&#41;&#44; linezolid drug costs were higher &#40;&#8364;1&#44;233<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>&#8364;590 vs&#46; &#8364;186<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>&#8364;246&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#44; while total medical costs &#40;&#8364;17&#44;219<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>&#8364;8&#44;792 vs&#46; &#8364;20&#44;263<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>&#8364;11&#44;350&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;51&#41; and total costs per patient-day &#40;&#8364;1&#44;000<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>&#8364;272 vs&#46; &#8364;1&#44;010<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>&#8364;312&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;98&#41; were numerically lower for linezolid vs&#46; vancomycin patients within the subgroup of patients who developed renal failure&#46; The difference in survival status at EOS between treatment groups was adjusted for by calculating economic cost per person-day&#46;</p></span></span></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0170">Discussion</span><p id="par0110" class="elsevierStylePara elsevierViewall">The current study highlights the economic burden associated with MRSA NP from a Spanish payer&#39;s perspective&#46; The results showed that there were no significant differences in treatment costs for linezolid- &#40;&#8364;17&#44;782&#41; and vancomycin-treated &#40;&#8364;17&#44;423&#41; patients&#46; Significantly higher drug cost for linezolid vs&#46; vancomycin therapy may have been partially offset by fewer renal failure events&#46; Bed costs were the main cost driver&#44; of which ICU costs constituted the highest proportion&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">To the best of our knowledge&#44; this is the largest study focusing on a Spanish payer&#39;s perspective that evaluates the economic burden of MRSA NP treatments using data from a randomized clinical trial&#46; Prior studies have evaluated the treatment costs of linezolid vs&#46; vancomycin in patients with MRSA NP from a US<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">11</span></a> and a China<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">15</span></a> perspective&#46; At the outset of this analysis&#44; it was unclear whether the conclusions from the prior US study would remain robust when the Spanish costs were applied&#44; due to fundamental differences in each country&#39;s healthcare system&#46; In Spain and most other European countries&#44; healthcare is universally covered and fully funded from taxes obtained from the public sector&#46; This means that health services are mostly free of charge at the point of delivery&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">16</span></a> In contrast&#44; healthcare in the US is not universally covered&#59; no single payer for healthcare exists&#46; China also has a different healthcare system compared to most of the western countries&#44; adopting increasing health care privatization&#44; and decentralization from the central government to provincial and local authorities&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">17</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">Although the main conclusions of this study are consistent with the prior US economic analysis&#44;<span class="elsevierStyleSup">11</span> there are some notable differences from the Spanish perspective&#46; A key difference in the findings is that the total costs and cost components were lower from a Spanish payer&#39;s perspective compared to the US for both treatment groups&#44; which is likely driven by the difference in unit costs&#46; In a cross-national study comparing the US healthcare system with other Organization for Economic Cooperation and Development &#40;OECD&#41; countries&#44; it was suggested that Americans have comparably fewer physician office visits and hospital days&#46; However&#44; the total medical expenditures in the US are twice as high per capita as most other OECD countries&#44; including Spain&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">18</span></a> This conclusion is consistent with our findings from the ZEPHyR trial that patients enrolled in European countries &#40;10&#37;&#41; had over 40&#37; longer LOS than the US &#40;63&#37;&#41; &#40;mean LOS&#58; 23 vs&#46; 16 days&#41; but lower total hospitalization costs for both treatment groups&#46; The incremental difference in total cost between the linezolid and vancomycin groups was the highest in our study &#40;&#8364;359&#41;&#44; followed by China &#40;&#165;1&#44;584<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8364;222&#41;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">15</span></a> and US &#40;&#36;107<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8364;102&#41; studies<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">11</span></a>&#46; As the incremental treatment success rate in linezolid vs&#46; vancomycin is &#8764;10&#37; &#40;55&#37; vs&#46; 45&#37;&#41;&#44; the incremental cost per additional treatment success at base case may be the highest in the current study compared to studies in the US &#40;&#36;16&#44;516 &#91;95&#37; CI&#58; &#8722;&#36;68&#44;620 to &#36;164&#44;478&#93;&#41; and in China &#40;&#165;15&#44;904 &#91;95&#37; CI&#58; &#8722;&#165;161&#44;935 to &#165;314&#44;987&#93;&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">11&#44;15</span></a> More details about the comparison of the prior US&#44; China and the current Spanish studies were provided in the <a class="elsevierStyleCrossRef" href="#sec0095">Supplemental table</a>&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Several additional modeling studies also evaluated the economic impact of linezolid and vancomycin therapy for patients with MRSA NP from various perspectives in the US and European countries&#46; Le&#243;n et al&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">10</span></a> evaluated the incremental cost-effectiveness ratio of linezolid vs&#46; vancomycin under a decision-analytical framework from a Spanish payer perspective&#46; The study concluded that linezolid was cost-effective against vancomycin&#44; with incremental cost&#47;life-years gained and death avoided below the acceptable threshold&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">10</span></a> Patel et al&#46; published two studies evaluating the cost-effectiveness of linezolid vs&#46; vancomycin from a US and German payer perspective&#46;<a class="elsevierStyleCrossRefs" href="#bib0305"><span class="elsevierStyleSup">19&#44;20</span></a> In Germany and the US&#44; they suggested that the cost-effectiveness ratio favored linezolid over vancomycin as linezolid-treated patients had greater efficacy and cost-offset by lower treatment failure-related costs in Germany and US&#46;<a class="elsevierStyleCrossRefs" href="#bib0305"><span class="elsevierStyleSup">19&#44;20</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">Although some economic data can be gleaned from the literature&#44; data on the economic burden associated with MRSA pneumonia are limited in Europe &#40;especially in Spain&#41; and varied widely across studies&#46; Results from a Spanish study evaluating data from 27 hospitals found that MRSA bacteremia was associated with a mean inpatient LOS of 25 days&#44; an ICU admission rate of 28&#46;7&#37;&#44; and treatment costs of &#8364;11&#46;884 per episode &#40;updated to 2012 Euros&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">21</span></a> A European study &#40;EUVAP&#41; concluded that patients who received inappropriate compared to appropriate empiric treatment had longer ICU stays by approximately 6 days&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">22</span></a> Our study results provide updated economic data on treatments of vancomycin and linezolid for MRSA NP&#44; emphasizing the importance of minimizing total medical costs and improving clinical outcomes through the use of appropriate antibiotics under the Spanish healthcare system and potentially that of other countries&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">It is important to understand this study&#39;s findings in the context of its limitations&#46; First&#44; the follow-up period for collecting HCRU items and cost calculation through EOS were limited in the study&#46; Length of stay was likely underestimated since &#8764;40&#37; of patients were hospitalized at the EOS visit and their discharge date was not captured&#46; This is a limitation often observed in clinical studies&#46; In most randomized clinical trials&#44; HCRU data are not usually collected after the EOS visit and are usually truncated when the clinical evaluation ends&#46; In our study&#44; the proportion of patients who remained hospitalized at EOS was balanced between treatment groups&#44; as was time to the EOS visit&#46; Therefore&#44; we would expect the effect on HCRU and cost differences between treatment groups to be minimal&#46; In addition&#44; the regression analysis adjusting for the difference in follow-up&#44; survival&#44; and region showed similar findings as in the descriptive analysis&#46; Second&#44; although we applied unit cost data from Spain to the study results&#44; the results were obtained primarily from patients hospitalized in the US which explains why our LOS was shorter than that reported for other European populations&#46; Given that the patients were randomly assigned into the treatment groups in each region&#44; the difference in HCRU and costs between treatments may not be largely impacted by this limitation&#46; Third&#44; the vancomycin doses used in this clinical trial<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">6</span></a> may not reflect dosing patterns in real-world clinical practice since vancomycin dosing was optimized within the randomized clinical trial&#46; Fourth&#44; this analysis was conducted in the mITT population&#46; Consequently&#44; this datum does not represent the HCRU or costs of empiric treatment for patients at risk for MRSA&#46; Lastly&#44; it is likely that this study was underpowered to detect differences in continuous HCRU and cost outcomes between treatment groups&#44; especially within the subgroup of patients who developed renal failure&#46; Therefore&#44; linezolid&#39;s benefits in the lower renal failure rate did not translate into a statistically significant difference in total medical cost when compared with vancomycin&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Despite these limitations&#44; our study results add evidence to demonstrate the importance of MRSA NP economic burden from a Spanish payer&#39;s perspective&#46; This study provides valuable information by quantifying the economic impact associated with two antibiotic treatments in Spain&#46; Decision makers may use this information to justify the need for strategies aimed at MRSA prevention&#44; and clinicians may use this information to understand the economic burden associated with antibiotic treatment strategies&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0175">Conclusion</span><p id="par0145" class="elsevierStylePara elsevierViewall">Focusing on a Spanish perspective&#44; our study provides updated data on the economic burden associated with linezolid and vancomycin treatment in patients with MRSA NP and the impact of renal failure on HCRU and costs&#46; It was found that HCRU and costs were similar for linezolid- and vancomycin-treated patients with MRSA NP during the study period by applying Spanish unit cost data to HCRU data collected from an international randomized clinical trial&#46; Linezolid&#39;s high drug acquisition costs were partially offset by fewer renal failure events which impacted ICU&#44; hospital bed&#44; and RRT costs&#46; The potential consequences of developing renal failure include increased mortality and treatment costs&#46; Future research is warranted to further explore the potential impact of linezolid and optimally-dosed vancomycin on HCRU&#44; including the risk of renal adverse events&#44; and the associated economic costs within the Spanish National Health System and other European countries&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0180">Authors&#8217; contributions</span><p id="par0150" class="elsevierStylePara elsevierViewall">Dr&#46; Jordi Rello&#44; Dr&#46; Jordi Sol&#233;-Viol&#225;n&#44; Dr&#46; Mercedes Nieto&#44; and Dr&#46; Jean Chastre contributed to study conceptualization and design&#46; Caitlyn T&#46; Solem&#44; Yin Wan&#44; and Xin Gao developed the analysis plan and methodology&#44; and performed the analysis&#46; Marina de Salas-Cansado&#44; Francisco Mesa&#44; and Claudia Charbonneau contributed to study conceptualization and methodology development&#46; All authors listed made substantial contributions to the study in conceptualization and&#47;or study design&#44; analysis and&#47;or data interpretation and manuscript preparation and&#47;or review&#46; All authors read&#44; edited&#44; and approved the final manuscript&#46;</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0185">Conflicts of interest</span><p id="par0155" class="elsevierStylePara elsevierViewall">This work was supported by Pfizer&#44; Inc&#46; Pharmerit International received consulting fees from Pfizer&#44; Inc&#46; in connection with this study and development of this manuscript&#46; Caitlyn T&#46; Solem&#44; Yin Wan&#44; and Xin Gao are employees of Pharmerit International&#46; Dr&#46; J Rello received an honorarium from Pfizer Inc&#46; in connection with his work on this study and has been a consultant and an advisory board member and has received honoraria for advice or public speaking for Pfizer Inc&#46; Dr&#46; Mercedes Nieto received an honorarium from Pfizer&#44; Inc&#46; in connection with work on this study&#44; has been a consultant and an advisory board member&#44; and has received honoraria for advice or public speaking for Pfizer&#44; Inc&#46; Dr&#46; Jordi Sol&#233;-Viol&#225;n received an honorarium from Pfizer&#44; Inc&#46; in connection with work on this study&#44; has been a consultant and an advisory board member&#44; and has received honoraria for advice or public speaking for Pfizer&#44; Inc&#46; Jean Chastre received an honorarium from Pfizer&#44; Inc&#46; in connection with work on this study&#44; has been a consultant and an advisory board member&#44; and has received honoraria for advice or public speaking for Pfizer&#44; Inc&#46; Francisco Mesa and Claudie Charbonneau are employees and shareholders of Pfizer&#44; Inc&#46; Marina de Salas-Cansado is a former employee of Pfizer&#44; Inc&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Adopting a unique Spanish perspective&#44; this study aims to assess healthcare resource utilization &#40;HCRU&#41; and the costs of treating nosocomial pneumonia &#40;NP&#41; produced by methicillin-resistant <span class="elsevierStyleItalic">Staphylococcus aureus</span> &#40;MRSA&#41; in hospitalized adults using linezolid or vancomycin&#46; An evaluation is also made of the renal failure rate and related economic outcomes between study groups&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Design</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">An economic <span class="elsevierStyleItalic">post hoc</span> evaluation of a randomized&#44; double-blind&#44; multicenter phase 4 study was carried out&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Scope</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Nosocomial pneumonia due to MRSA in hospitalized adults&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Participants</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The modified intent to treat &#40;mITT&#41; population comprised 224 linezolid- and 224 vancomycin-treated patients&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Interventions</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Costs and HCRU were evaluated between patients administered either linezolid or vancomycin&#44; and between patients who developed renal failure and those who did not&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Primary endpoints</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Analysis of HCRU outcomes and costs&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Total costs were similar between the linezolid- &#40;&#8364;17&#44;782<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>&#8364;9&#44;615&#41; and vancomycin-treated patients &#40;&#8364;17&#44;423<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>&#8364;9&#44;460&#41; &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;69&#41;&#46; The renal failure rate was significantly lower in the linezolid-treated patients &#40;4&#37; vs&#46; 15&#37;&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#46; The total costs tended to be higher in patients who developed renal failure &#40;&#8364;19&#44;626<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>&#8364;10&#44;840 vs&#46; &#8364;17&#44;388<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>&#8364;9&#44;369&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;14&#41;&#46; Among the patients who developed renal failure&#44; HCRU &#40;days on mechanical ventilation&#58; 13&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#46;7 vs&#46; 7&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;6 days&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;21&#59; ICU stay&#58; 14&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#46;5 vs&#46; 9&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#46;6 days&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;30&#59; hospital stay&#58; 19&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;5 vs&#46; 16&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#46;0 days&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;26&#41; and cost &#40;&#8364;17&#44;219<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>&#8364;8&#44;792 vs&#46; &#8364;20&#44;263<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>&#8364;11&#44;350&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;51&#41; tended to be lower in the linezolid- vs&#46; vancomycin-treated patients&#46; There were no statistically significant differences in costs per patient-day between cohorts after correcting for mortality &#40;&#8364;1000 vs&#46; &#8364;1&#44;010&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;98&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">From a Spanish perspective&#44; there were no statistically significant differences in total costs between the linezolid and vancomycin pneumonia cohorts&#46; The drug cost corresponding to linezolid was partially offset by fewer renal failure adverse events&#46;</p></span>"
        "secciones" => array:8 [
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            "identificador" => "abst0015"
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            "identificador" => "abst0020"
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            "identificador" => "abst0025"
            "titulo" => "Interventions"
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            "identificador" => "abst0030"
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      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Objetivos</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Analizar la utilizaci&#243;n de recursos sanitarios &#40;URS&#41; y los costes de la neumon&#237;a nosocomial por <span class="elsevierStyleItalic">Staphylococcus aureus</span> resistente a meticilina en adultos hospitalizados tratados con linezolid o vancomicina&#46; Tambi&#233;n se evalu&#243; el porcentaje de fallo renal entre dichos pacientes&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Dise&#241;o</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">An&#225;lisis <span class="elsevierStyleItalic">post-hoc</span> de un ensayo cl&#237;nico fase <span class="elsevierStyleSmallCaps">iv</span> multic&#233;ntrico&#44; aleatorizado&#44; doble ciego&#46;</p></span> <span id="abst0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">&#193;mbito</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Pacientes adultos&#44; hospitalizados con neumon&#237;a nosocomial por <span class="elsevierStyleItalic">Staphylococcus aureus</span> resistente a meticilina&#46;</p></span> <span id="abst0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Participantes</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Pacientes tratados con linezolid &#40;224&#41; o vancomicina &#40;224&#41;&#46;</p></span> <span id="abst0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Intervenciones</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Desde la perspectiva espa&#241;ola se compararon costes y URS entre pacientes tratados con linezolid o vancomicina y entre los que desarrollaron fallo renal y los que no&#46;</p></span> <span id="abst0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Principales variables de inter&#233;s</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">An&#225;lisis de costes y URS&#46;</p></span> <span id="abst0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Resultados</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Los costes totales fueron similares &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;69&#41; en los pacientes tratados con linezolid &#40;17&#46;782<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;615<span class="elsevierStyleHsp" style=""></span>&#8364;&#41; o vancomicina &#40;17&#46;423<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;460<span class="elsevierStyleHsp" style=""></span>&#8364;&#41;&#46; La tasa de fallo renal fue significativamente menor en los tratados con linezolid &#40;4 vs&#46; 15&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; Los costes totales fueron mayores en aquellos que desarrollaron fallo renal &#40;19&#46;626<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#46;840<span class="elsevierStyleHsp" style=""></span>&#8364; vs&#46; 17&#46;388<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;369<span class="elsevierStyleHsp" style=""></span>&#8364;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;14&#41;&#46; La URS &#40;d&#237;as de ventilaci&#243;n mec&#225;nica&#58; 13&#44;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#44;7 vs&#46; 7&#44;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;6&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;21&#59; d&#237;as en UCI&#58; 14&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#44;5 vs&#46; 9&#44;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#44;6&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;30&#59; d&#237;as de hospitalizaci&#243;n&#58; 19&#44;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#44;5 vs&#46; 16&#44;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#44;0&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;26&#41; y los costes totales &#40;17&#46;219<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;792<span class="elsevierStyleHsp" style=""></span>&#8364; vs&#46; 20&#46;263<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#46;350<span class="elsevierStyleHsp" style=""></span>&#8364;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;51&#41; tendieron a ser inferiores en los pacientes tratados con linezolid que desarrollan fallo renal&#46; Tras corregir el an&#225;lisis por mortalidad&#44; los costes diarios por paciente fueron similares &#40;1&#46;000 vs<span class="elsevierStyleItalic">&#46;</span> 1&#46;010<span class="elsevierStyleHsp" style=""></span>&#8364;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;98&#41;&#46;</p></span> <span id="abst0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conclusiones</span><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Desde la perspectiva espa&#241;ola&#44; no hubo diferencias en la URS y los costes entre los pacientes con neumon&#237;a tratados con linezolid o vancomicina&#46; El coste de linezolid fue contrarrestado por la menor incidencia de fallo renal&#46;</p></span>"
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            "identificador" => "abst0045"
            "titulo" => "Objetivos"
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            "titulo" => "Dise&#241;o"
          ]
          2 => array:2 [
            "identificador" => "abst0055"
            "titulo" => "&#193;mbito"
          ]
          3 => array:2 [
            "identificador" => "abst0060"
            "titulo" => "Participantes"
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            "identificador" => "abst0065"
            "titulo" => "Intervenciones"
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            "titulo" => "Principales variables de inter&#233;s"
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            "titulo" => "Resultados"
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            "apendice" => "<p id="par0175" class="elsevierStylePara elsevierViewall">The following are the supplementary data to this article&#58;<elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>"
            "etiqueta" => "Appendix A"
            "titulo" => "Supplementary data"
            "identificador" => "sec0100"
          ]
        ]
      ]
    ]
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      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
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        "mostrarDisplay" => false
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          0 => array:4 [
            "imagen" => "gr1.jpeg"
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        "descripcion" => array:1 [
          "en" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Patient flow chart&#46; <span class="elsevierStyleItalic">Abbreviations</span>&#58; mITT&#44; modified intent to treat&#46;</p>"
        ]
      ]
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        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
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          "en" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Total costs &#40;by component&#41; per patient by treatment group &#40;mITT population&#41;&#46; <span class="elsevierStyleItalic">Note</span>&#58; Costs are given in 2012 Euros&#46; The study drug cost for vancomycin group includes the cost of drug and cost for testing the vancomycin levels&#46; <span class="elsevierStyleItalic">Abbreviations</span>&#58; MV&#44; mechanical ventilation&#59; mITT&#44; modified intent to treat&#59; RRT&#44; renal replacement therapy&#46;</p>"
        ]
      ]
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        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
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          "leyenda" => "<p id="spar0100" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Abbreviations</span>&#58; HD&#58; hemodialysis&#59; HF&#58; hemofiltration&#59; LTC&#58; long-term care&#59; ICU&#58; intensive care unit&#59; CRRT&#58; continuous renal replacement therapy&#59; IRRT&#58; intermittent renal replacement therapy&#46;</p>"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">HCRU item&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Description&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Unit cost &#40;&#8364;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Unit&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Source&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Study medications</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Linezolid&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Linezolid IV &#40;600<span class="elsevierStyleHsp" style=""></span>mg per dose&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">59&#46;61&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Per 600<span class="elsevierStyleHsp" style=""></span>mg vial&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Botplus-Portalfarma<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">11</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Vancomycin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Vancomycin IV 15<span class="elsevierStyleHsp" style=""></span>mg&#47;kg per dose&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#46;90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Per 1000<span class="elsevierStyleHsp" style=""></span>mg vial&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Botplus-Portalfarma<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">11</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Vancomycin level&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Laboratory test for monitoring vancomycin levels&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&#46;55&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Per level&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Oblikue database<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">12</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Bed cost</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>ICU&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Intensive care unit&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1127&#46;25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Per day&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Oblikue database<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">12</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Step down&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Step down&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">851&#46;35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Per day&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Oblikue database<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">12</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>General ward&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">General ward&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">575&#46;46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Per day&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Oblikue database<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">12</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>LTC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Nursing home&#47;LTC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">156&#46;15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Per day&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Oblikue database<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">12</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Rehabilitation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Rehabilitation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">488&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Per day&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Oblikue database<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">12</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Others</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Mechanical ventilator&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Mechanical ventilator&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Per day&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Oblikue database<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">12</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Hemofiltration&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">CRRT &#8211; hemofiltration&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">253&#46;59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Per HF day&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Oblikue database<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">12</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Hemodialysis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">IRRT &#8211; hemodialysis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">184&#46;88&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Per HD day&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Oblikue database<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">12</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "leyenda" => "<p id="spar0110" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Abbreviations</span>&#58; APACHE&#44; Acute Physiology and Chronic Health Evaluation&#59; EOS&#44; end of study&#59; HCRU&#44; healthcare resource utilization&#59; ICU&#44; intensive care unit&#59; mITT&#44; modified-intent to treat&#59; SD&#44; standard deviation&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variables&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Non-Renal Failure &#40;<span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>405&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Renal Failure &#40;<span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>43&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span>-value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleBold">Demographic variables</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Age&#44; mean &#40;SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">61&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>18&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">64&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>16&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Median &#40;range&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">66 &#40;18&#44; 98&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">69 &#40;24&#44; 86&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Male&#44; No&#46; &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">266 &#40;66&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">28 &#40;65&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;94&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Region&#44; No&#46; &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>United States&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">261 &#40;64&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22 &#40;51&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Asia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">49 &#40;12&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;19&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Europe&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">40 &#40;10&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Latin America&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">38 &#40;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;16&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Other&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17 &#40;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleBold">Follow-up characteristics</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Length since randomization until EOS in days&#44; mean &#40;SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">23&#46;6 &#40;10&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&#46;3 &#40;9&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">&#46;04</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Patients in hospital at the EOS visit&#44; No&#46; &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">159 &#40;39&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16 &#40;37&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;79&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Patients died at EOS&#44; No&#46; &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">53 &#40;13&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11 &#40;25&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">&#46;04</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleBold">Clinical variables</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Co-morbidities&#44; No&#46; &#40;&#37;&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">b</span></a></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Atrial fibrillation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">89 &#40;22&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12 &#40;28&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;39&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Chronic obstructive pulmonary disease &#40;COPD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">119 &#40;30&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;16&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;07&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Diabetes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">159 &#40;40&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24 &#40;56&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">&#46;04</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Peripheral vascular disorder &#40;PVD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">51 &#40;13&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;12&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;84&nbsp;\t\t\t\t\t\t\n
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        "texto" => "<p id="par0165" class="elsevierStylePara elsevierViewall">The authors would like to thank Jennifer Stephens from Pharmerit International for her contribution in the study design&#44; analysis plan&#44; and results interpretation and Beth Lesher for editorial assistance&#46; We appreciate the work from the following team members of our original US study using the same clinical trial data&#58; Dr&#46; Mike Niederman from the Winthrop-University Hospital&#44; Richard Chambers&#44; Daniela E&#46; Myers&#44; Seema Haider&#44; and Jim Z&#46; Li from Pfizer&#44; Inc&#46;&#44; and Professor Ben van Hout from the University of Sheffield&#46;</p>"
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Article information

ISSN: 21735727
Original language: English

DOI:10.1016/j.medine.2016.01.003

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Year/Month	Html	Pdf	Total

2024 November	5	10	15
2024 October	40	38	78
2024 September	38	32	70
2024 August	49	37	86
2024 July	33	22	55
2024 June	41	51	92
2024 May	46	24	70
2024 April	47	36	83
2024 March	34	31	65
2024 February	32	42	74
2024 January	28	25	53
2023 December	33	38	71
2023 November	51	41	92
2023 October	51	32	83
2023 September	32	30	62
2023 August	30	15	45
2023 July	35	23	58
2023 June	22	17	39
2023 May	42	31	73
2023 April	66	17	83
2023 March	88	28	116
2023 February	91	32	123
2023 January	54	22	76
2022 December	65	41	106
2022 November	65	39	104
2022 October	55	50	105
2022 September	28	45	73
2022 August	47	31	78
2022 July	45	30	75
2022 June	27	23	50
2022 May	76	35	111
2022 April	33	28	61
2022 March	37	43	80
2022 February	23	28	51
2022 January	20	30	50
2021 December	52	46	98
2021 November	29	43	72
2021 October	45	64	109
2021 September	28	36	64
2021 August	28	38	66
2021 July	37	35	72
2021 June	31	28	59
2021 May	40	43	83
2021 April	88	91	179
2021 March	56	31	87
2021 February	36	31	67
2021 January	40	18	58
2020 December	23	13	36
2020 November	24	12	36
2020 October	33	26	59
2020 September	33	19	52
2020 August	35	15	50
2020 July	32	19	51
2020 June	32	17	49
2020 May	24	13	37
2020 April	20	8	28
2020 March	10	11	21
2020 February	46	22	68
2020 January	24	22	46
2019 December	22	10	32
2019 November	34	32	66
2019 October	33	15	48
2019 September	25	21	46
2019 August	18	18	36
2019 July	25	24	49
2019 June	19	15	34
2019 May	40	24	64
2019 April	15	14	29
2019 March	19	21	40
2019 February	25	24	49
2019 January	26	26	52
2018 December	28	32	60
2018 November	80	38	118
2018 October	24	35	59
2018 September	19	4	23
2018 August	16	8	24
2018 July	14	9	23
2018 June	19	7	26
2018 May	6	1	7
2018 April	15	5	20
2018 March	12	4	16
2018 February	13	8	21
2018 January	13	9	22
2017 December	12	5	17
2017 November	12	8	20
2017 October	15	7	22
2017 September	9	8	17
2017 August	14	4	18
2017 July	17	6	23
2017 June	18	6	24
2017 May	20	8	28
2017 April	30	13	43
2017 March	10	0	10
2017 February	7	0	7
2017 January	1	0	1
2016 December	2	0	2
2016 November	3	1	4

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