In 2013, HealthTrust’s Pharmacy Services team completed the first phase of a three-phase study that examined how appropriately and effectively hospitals are using high-powered antibiotics to combat dangerous MRSA infections among their patients. The first phase was a retrospective analysis that looked at the antibiotics hospitals used to treat MRSA infections, when they chose to switch to a secondary medication and which agents they chose.
Between mid-2008 and mid-2013, members spent about $170 million on MRSA treatments annually.
Cost was another factor HealthTrust examined as part of the analysis. Between mid-2008 and mid-2013, members had spent about $170 million per year on MRSA treatments.
“That’s a substantial amount of money,” says Marcus J. Dortch, PharmD, FCCM, BCPS, former director of clinical pharmacy services for HealthTrust, “so our team hoped to determine if and when hospitals were treating MRSA infections with the most appropriate drugs and thus balancing costs.”
The HealthTrust study examined information on approximately 3,000 patients in 125 participating hospitals.
Charting the Cost of Anti-MRSA Agents
Many MRSA infections still respond very well to vancomycin, the first-line treatment that has been around for many decades. Vancomycin is also significantly cheaper than many newer drugs, some of which are not yet available in more cost-effective generic forms.
However, there are cases in which vancomycin is determined not to be effective enough at fighting off the infection. The term “vancomycin MIC creep” is used to describe the way in which resistance to this antibiotic gradually creeps up. (MIC stands for minimum inhibitory concentration.) That’s a concern for facilities because it means that this first-line drug is no longer working as well as it used to, which can complicate treatment, or at least prompt clinicians to use the newer drugs.
“Hospitals will be able to be more confident in their abilities to address this fast-moving infection. Time is of the essence, so you want to get the right antibiotics on as quickly as possible.”
— Marcus J. Dortch, PharmD, FCCM, BCPS, director of clinical pharmacy services
“Because the newer drugs are high-cost drugs, we wanted to make sure they’re used correctly,” Dortch says.
One of the other drugs examined in the study was a novel lipopeptide antibiotic called daptomycin. It’s an agent approved for the treatment of complicated skin and skin structure infections (cSSSIs) and bloodstream/heart valve infections caused by bacteria such as MRSA. Also known by the brand name Cubicin, daptomycin was approved by the U.S. Food and Drug Administration in 2003, and no generic is yet available.
HealthTrust’s cost analysis of data from the 125 participating hospitals found that the mean cost per patient course of daptomycin during the study was $1,935.31, compared to vancomycin’s $42.89.
The other agents analyzed in this study also cost more than a course of vancomycin. The following chart is broken down by agent and mean cost per patient course:
| Agent | Mean cost per patient course |
|---|---|
| Daptomycin | $,935.31 |
| Linezolid IV | $1,420.46 |
| Linezolid PO | $1,285.58 |
| Tigecycline | $974.98 |
Identifying Areas for Improvement
The researchers analyzed data and identified five main areas of improvement:
1. Sub-therapeutic vancomycin levels
2. Inconsistent initial vancomycin weight-based dosing approach
3. Inconsistent initial daptomycin weight-based dosing approach
4. Inappropriate empiric MRSA therapy
5. Lack of MIC assessment/no MICs reported
Each participating hospital was given information on the specific areas in which they needed improvement and, in some cases, protocols to help them make those improvements.
Now that the first phase of the study is complete, the second phase is underway, as hospitals work on implementing best practices for treating MRSA appropriately with antibiotics. In phase three, which began late in 2013, the hospitals that originally participated were asked to report on changes they’d made and successes they’d realized.
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