OBJECTIVES: Ceftobiprole is a new i.v. anti-infective, which has bactericidal activity against difficult to treat Gram-positive (including multidrug-resistant pneumococci and methicillin-resistant Staphylococcus aureus; MRSA) and Gram-negative (including Pseudomonas aeruginosa) bacteria, which are important aetiological agents of nosocomial pneumonia (NP) and hospitalised community-acquired pneumonia (CAP). The objective of this analysis was to estimate the economic value of ceftobiprole(TID) compared to linezolid (BID)/ceftazidime (TID) in the treatment of hospitalised pneumonia patients in Scotland,when coverage of MRSA and Gram-negative pathogens, including P. aeruginosa, is required. METHODS: A cost-minimisation analysis, including only direct medical (drug) costs, was considered appropriate since the ceftobiprole phase 3 trials in NP and CAP demonstrated that ceftobiprole is non-inferior to a combination therapy consisting of linezolid and ceftazidime (NP) or ceftriaxone with or without linezolid (CAP). The base case model included drug acquisition, treatment duration, and administration costs. In additional scenario analyses, the cost-minimisation analysis included ICU and total hospitalisation costs as well. The resource use data were derived from the NP trial. RESULTS: Treatment with ceftobiprole resulted in a cost-saving of £257 per treated patient compared to linezolid/ceftazidime therapy. While no change in the drug budget is estimated, cost-savings are expected due to less administration time. Scenario analyses evaluated the reduction in length of ICU stay and overall hospital stay that will potentially lead to further cost savings for NHS Scotland (-£6,109 and -£1,259 per treated patient, respectively). CONCLUSIONS: This economic evaluation shows that ceftobiprole is at least a cost-neutral alternative to a combination of linezolid with ceftazidime and provides an effective and safe alternative for hospitalised pneumonia patients in Scotland.