OBJECTIVES: The objective of this research is to evaluate the cost-effectiveness of linezolid 600mgBID(LI), vancomycin 1gBID(VA) and teicoplanin 400mgBID(TE) in the treatment of nosocomial pneumonia caused by MRSA under the private health care system perspective. METHODS: To compare the options, a decision tree model was built considering an arm per treatment option, from which patients could respond to the initial treatment and continue to maintenance treatment using the same antibiotics, or do not respond, and repeat the treatment with assumed 50% chance to use one of the other two antibiotics. Clinical or microbiological effectiveness could be used as determinants of response. Effectiveness measures were mortality, clinical and microbiological responses, calculated by an indirect comparison of a literature systematic review. Hospitalization days were evaluated. Only direct costs were considered, and were obtained from CBHPM2010 for medical procedures, CMED December2012, considering X-factory price plus 18% tax for medications and BRASINDICE December2012 for materials. Values were represented in 2012USD. A time horizon of 1 year was considered. RESULTS: Clinical response rates were 66.5%(VA), 68.3%(TE), 72.6%(LI), microbiological response rates were 56.1%(VA), 55.9%(TE), 64.4%(LI), mortality rates were 15.74%(VA), 13.56%(TE), 10.13%(LI). If clinical response was considered as a determinant of success, the treatment costs would be US$33,190.76(VA), US$41,657.71(TE), US$27,036.62(LI), hospitalization days would be 41(VA), 39(TE), 26(LI), and if microbiological response was considered, the treatment costs would be US$34,597.12(VA); US$42,574.61(TE), US$28,514.48(LI) and hospitalization days would be 42(VA), 40(TE), 28(LI). Incremental cost-effectiveness ratios for TE and LI when compared to VA for clinical response were US$470,386.13, -US$100,887.50(dominant), and for microbiological response were -US$398,874.67(dominated), -US$73,284.78(dominant) respectively. CONCLUSIONS: Compared to vancomycin, teicoplanin was either dominated or did not reach cost-effectiveness considering a willingness to pay of US$32,621.93 (3xBrazilian GDP per capita), whereas linezolid was dominant, presenting lower mortality while offsetting costs, mainly driven by less hospitalization days at private health care services.