OBJECTIVES: Vancomycin has been the treatment of choice for several years while linezolid is a relatively new alternative in China. Although clinical superiority of linezolid was demonstrated in a recent head-to-head clinical study, economic evaluation comparing the two treatments provides additional useful decision making information. This study aimed to compare the cost-effectiveness of linezolid versus vancomycin in treating confirmed MRSA NP from a payer’s perspective in Nanjing. METHODS: A cost-effectiveness model primarily driven by the head-to-head clinical data (Wunderink, CID: 2012), was adapted with local published data and expert opinion on resource use and unit costs. The model structure and assumptions were verified to reflect local clinical practice. Both linezolid and vancomycin arms were assumed to have same life expectancy in full health upon discharge. The base case analysis considered 10-day treatment duration for both treatments. Scenario analyses were conducted by varying treatment duration, per day total costs in ICU and general ward, drug acquisition costs, and including costs for managing key adverse events. All costs were reported in 2012 Chinese RMB. RESULTS: A higher treatment success rate by 2.7% was predicted for linezolid. Both treatment arms were estimated to have very similar average total costs in the region of RMB 78,800 with the key cost drivers being drug acquisition costs and ICU per day total cost. The ICER for linezolid was RMB 163 for each additional successfully treated patient. Dominance of linezolid attributed to greater treatment success but lower total cost was observed in most of the scenario analyses. The highest ICER was RMB 31,663 in the scenario where the acquisition cost of vancomycin reduced by 20%. CONCLUSIONS: Given the estimated low ICERs with dominance in most of the scenario analyses, linezolid can be considered a cost effective option compared to vancomycin in managing confirmed MRSA NP in Nanjing.