This study aimed to identify the most cost-effective vancomycin dosage regimen to treat ventilator-associated pneumonia (VAP) in critically ill patients infected with “minimum inhibitory concentration (MIC) Creep” Methicillin-resistant Staphylococcus aureus (MRSA). Decision tree analysis with a healthcare provider perspective was used in this study. Clinical data, both efficacy and safety, were derived from Monte Carlo Simulation (MCS). Only direct medical cost was calculated in this study without any discounting factor analysis. The most cost-effective dosage regimen is the dosage regimen with the lowest incremental cost-effectiveness ratio (ICER). MCS found that the standard dose of vancomycin (2 g/day) was ineffective in treating MRSA with MIC 2 mg/l. The dosage regimen with a total daily dose of 4 g afforded the highest efficacy for all MIC values of MRSA. Nevertheless, this dosage regimen also afforded the highest risk of nephrotoxicity. The dosage regimen with a total daily dose of 3 g vancomycin attained a relatively good efficacy and safety profile. The ICER for vancomycin 1 g every 8 hours, 1 g every 6 hours, 1.5 g every 12 hours, and 2 g every 12 hours were 50,464; 58,998; 49,809; and 57,153, respectively. Vancomycin 1.5 g every 12 hours was the most cost-effective dosage regimen to treat VAP patients without advanced renal impairment in the era of “MIC Creep” MRSA.
Key words: Cost-effectiveness analysis, methicillin-resistant Staphylococcus aureus, Monte Carlo simulation, vancomycin, ventilator-associated pneumonia.
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