Cost of nosocomial pneumonia: the example of vancomycin versus linezolid—shorter stay or fewer complications?

Hospital and national committees often focus on drug acquisition costs when taking decisions on the use of new drugs, but antimicrobial agent costs represent a minor part of the bill compared with the indirect costs of hospitalization or loss in days of productivity in working people. Although reducing the length of stay should be a main priority in the USA due to the indirect costs associated with hospitalization, adverse events, such as renal failure, have a major impact on healthcare resource use and costs. However, where hospital reimbursement is based on closed budgets, the paradox is that treating more patients due to reductions in length of stay may not be attractive to administrators, because the cost of discharging patients earlier is not compensated by the increase in severity in replacing stays of newer patient admissions. Furthermore, neuropsychological, physical, and immune impairment caused by sepsis has an extreme impact on long-term quality of patient life and health care resource consumption. Future research is warranted to further explore the potential impact of newer therapies for infections and sepsis, taking into account the costs of complications, effects on long-term quality of life, and particularly an international perspective, which requires customization for each national payer's system.