Cost considerations in the evaluation of new therapies for gram-positive bacteria

The rapid emergence of antibiotic resistance in hospitals and the community, particularly amongst Gram-positive cocci, has not been paralleled by adequate understanding of the true clinical and economic impact of infection with resistant pathogens. Furthermore, the development of novel compounds to combat this threat has been slow until recently when a number of new agents, some with a unique structure and mode of action (e.g. linezolid), are now being developed for clinical use. This paper aims to outline (1) the costs associated with infection by a resistant organism (2) the pharmacoeconomic arguments when considering a new drug and (3) the key decisions when evaluating a new drug such as linezolid, for inclusion in a formulary or policy with particular reference to the treatment of serious Gram-positive infections.