OBJECTIVES: Complicated skin and soft tissue infections (cSSTIs) are associated with high healthcare resource use and costs. To achieve early response (ER) and possibly earlier discharge, thus reducing hospital expenditure, the appropriate choice of initial antibiotic therapy is crucial, particularly for patients at risk of treatment failure.

METHODS: A cost-minimization model was developed to evaluate the use of ceftaroline fosamil (CFT) (600mg q12hr) as an alternative to other antibiotic therapies (vancomycin 1g/q12hr, linezolid 600mg/q12hr, daptomycin 4-10mg/Kg/day, cloxacillin 1-2g/q4-6hr, tedizolid 200mg/q24hr) for the empiric treatment of hospitalized patients with cSSTI. The model perspective was the Spanish National Health System.

CFT clinical cure and ER rates were derived from the pooled analysis of CANVAS 1&2 trials (multicenter-Phase III RCTs). The clinical cure rates for the comparators were derived from a network meta-analysis while ER rates, antibiotic treatment duration and hospital resource use were sourced from the literature and validated by clinical experts. Extensive sensitivity analyses were performed.

RESULTS: CFT demonstrated similar costs and percentage of early discharged patients (PDE) than the comparators investigated.

CFT resulted in average PDE of 24.6% (CI 19.49%-30.2%) with average total cost per patient of €6,763 (CI €6,268-€7,219).

Vancomycin, linezolid, daptomycin and tedizolid resulted in average PDE of 22% (17.34%-27.09%), 26.4% (20.5%-32.32%), 28.6% (22.08%-35.79%) and 26.5% (20.39%-33.25%) respectively for a total cost per patient of €6,619 (€5,902-€6,929), €6,394 (€5,881-€6,904), €6,855 (€5,800-€7,410) and €7,173 (€6,608-€7,763) respectively.

Cloxacillin ER rate of 50.2%-53.3% (depending on dosage) resulted in total cost neutrality compared with CFT, with direct comparison hampered by the significantly different ER criteria utilized in the literature.

Deterministic sensitivity analysis demonstrated that ER and antibiotic treatment duration are the key drivers of total costs.

CONCLUSIONS: Given its clinical and safety profile, CFT is an acceptable choice for cSSTI empiric therapy providing costs and ER similar to other relevant antibiotic options.