OBJECTIVES: . The ventilator associated pneumonia (VAP) refers to the pneumonia that appears after 48-72 hours of endotracheal intubation and is the most common nosocomial infections in patients receiving mechanical ventilation. Late-onset VAP is responsible for prolonged ICU stay and higher mortality rates (24 to 50% and can even increase to 76%), which explains the importance of using more effective antibiotics depending on the severity of each case. The aim of this study is to assess the cost-effectiveness (CE) of linezolid against vancomycin in the treatment of VAP, from the public healthcare perspective. METHODS: . A cohort of patients with VAP was simulated using a decision-tree model to compare costs and effectiveness of linezolid (600 mg/12 hours) and vancomycin (1 g/12 hours). Effectiveness measures were: microbiological success rates, mortality rates, and ICU and ward LOS. The model used a 12-week time horizon and only direct medical costs were considered (inpatient costs, medication expenses, adverse events costs). Effectiveness and epidemiologic data were retrieved from published literature.  Local costs (2013 US$) were gathered from the official databases of Jamaican Health System. Monte Carlo probabilistic sensitivity analysis (PSA) was constructed. RESULTS: .  Linezolid resulted as the most effective and less expensive option for VAP adult patients. Clinical success rate was higher with linezolid (64.4%) against vancomicyn (56.1%).  Mean expected ICU LOS was 14 days for linezolid and 17 days for vancomycin, ward LOS was 14 and 24 days with linezolid and vancomycin, respectively.  Mortality rate was found lower in the linezolid arm (10.13%) in comparison to vancomycin (15.74%).  Overall costs per patient were $36721.65 with linezolid and $40776.82 with vancomycin.  In the CE incremental analysis, linezolid appeared as the cost-saving option. PSA outcomes support the robustness of these findings.  CONCLUSIONS: . Linezolid resulted as the cost-saving therapy for treating VAP adult patients in Jamaica.