BURLINGTON, Mass.--()--Decision Resources, one of the world’s leading research and advisory firms for pharmaceutical and healthcare issues, finds that vancomycin continues to dominate the treatment of MRSA due to its high cost-effectiveness, physician familiarity and favorable formulary positioning. Although vancomycin was selected by the majority of surveyed infectious disease (ID) specialists and primary care physicians (PCPs) as the most prescribed antibiotic for skin and skin structure infections (SSSIs) due to MRSA, less than a third of physicians consider it the preferred antibiotic for this indication.
“ID specialists and PCPs prescribe OPAT to a similar percentage of their patients. Both surveyed ID specialists and PCPs indicate that vancomycin is prescribed to approximately half of patients with MRSA infections who are discharged on OPAT”
The new U.S. Physician & Payer Forum report entitled Hospital-Acquired Infections: How is the U.S. Launch of Premium-Priced Antibiotics for C. difficile and MRSA Affecting Physician Prescribing and Payer Reimbursement Decisions? also finds that ID specialists and PCPs have differential preferences for Cubist/Novartis/Merck’s Cubicin and Pfizer’s Zyvox, respectively, as their preferred anti-MRSA antibiotic brands. Such preferences are observed for all indications surveyed—cSSSIs, bloodstream infections, endocarditis and osteomyelitis—except for nosocomial pneumonia, given that Cubicin is not effective in the lung due to inactivation by surfactant. PCPs’ preferences are likely driven by factors such as familiarity, access, budget restrictions, exposure to marketing as well as the availability of dual oral/IV formulation for Zyvox but not Cubicin. Additionally, for the treatment of C. difficile, the use of IV vancomycin compounded for oral administration as a capsule or a slurry remains common with ID specialists, despite the availability of generic oral vancomycin. Among PCPs, generic vancomycin accounts for almost 60 percent of use of oral vancomycin, whereas oral preparations of IV vancomycin are the least common.
Although both ID specialists and PCPs indicate that approximately half of patients hospitalized with MRSA infections get discharged on oral antibiotic therapy, a third of patients continued IV treatment in the outpatient setting (OPAT).
“ID specialists and PCPs prescribe OPAT to a similar percentage of their patients. Both surveyed ID specialists and PCPs indicate that vancomycin is prescribed to approximately half of patients with MRSA infections who are discharged on OPAT,” said Decision Resources Therapeutic Area Directors Irene Koulinska, M.D., Sc.D. “However, as has been the case with hospital prescribing, ID specialists prescribe Cubicin to a higher percentage of their OPAT patients (24 percent versus 4 percent for PCPs), whereas Zyvox IV is favored over Cubicin by PCPs despite Cubicin’s more convenient once-daily dosing.”
The report also finds that surveyed physicians and hospital pharmacy directors indicate that Zyvox is more likely to be included on formularies and less likely to face prescribing restrictions compared with Cubicin, further contributing to ID specialists’ and PCPs’ differential preferences for Cubicin and Zyvox, respectively. Theravance’s Vibativ, Forest/AstraZeneca/Dainippon Sumitomo’s Teflaro and Optimer’s Dificid are the antibiotics least likely to be included on formulary, likely due to difficulties in differentiating from marketed agents and relatively recent launch, respectively.
Approximately half of surveyed PDs will not include the emerging oxazolidinone tedizolid (Trius) on their formularies if priced at a 10 percent premium to Zyvox, likely because they do not currently see it as sufficiently differentiated from Zyvox. The percentage of pharmacy directors who consider including tedizolid on their formularies with the requirement for an ID consult is similar whether the drug is priced at a 10 percent discount to Zyvox or the same as Zyvox, although prescribing restrictions are less likely at the lower price.
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