{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T04:42:11Z","timestamp":1790484131358,"version":"4.1.0"},"reference-count":56,"publisher":"Oxford University Press (OUP)","issue":"11","license":[{"start":{"date-parts":[[2021,10,4]],"date-time":"2021-10-04T00:00:00Z","timestamp":1633305600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100005332","name":"Alpha Omega Alpha Honor Medical Society","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100005332","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,11,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Methicillin-sensitive Staphylococcus aureus (MSSA) bacteremia is associated with significant morbidity, mortality, and hospitalization costs. Cefazolin and antistaphylococcal penicillins (ASPs), such as nafcillin, are the preferred treatments for MSSA bacteremia. The aim of this study was to compare the cost-effectiveness of each approach.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We constructed a decision-analytic model comparing the use of cefazolin with ASPs for the treatment of MSSA bacteremia. Cost-effectiveness was determined by calculating deaths averted and incremental cost-effectiveness ratios (ICERs). Uncertainty was addressed by plotting cost-effectiveness planes and acceptability curves for various willingness-to-pay thresholds.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In the base-case analysis, the cost associated with the cefazolin strategy was $38 863.1, and the associated probability of survival was 0.91. For the ASP strategy, the cost was $48 578.8, and the probability of survival was 0.81. The incremental difference in cost between the 2 strategies was $9715.7, with hospital length of stay being the main driver of cost, and the incremental difference in effectiveness was 0.10. Overall, cefazolin results in savings of $97 156.8 per death averted (ICER, $\u201397 156.8\/death averted). In the probabilistic analysis, at a willingness-to-pay of $50 000, cefazolin had a 68% chance of being cost-effective compared with ASPs. In cost-effectiveness acceptability curves, the cefazolin strategy was cost-effective in 73.5%\u201381.8% of simulations compared with ASP for a willingness-to-pay ranging up to $50 000.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The use of cefazolin is a cost-effective strategy for the treatment of MSSA bacteremia and, when clinically appropriate, this strategy results in considerable health care cost-savings.<\/jats:p><\/jats:sec>","DOI":"10.1093\/ofid\/ofab476","type":"journal-article","created":{"date-parts":[[2021,10,4]],"date-time":"2021-10-04T05:21:56Z","timestamp":1633324916000},"source":"Crossref","is-referenced-by-count":8,"title":["The Cost-effectiveness of Cefazolin Compared With Antistaphylococcal Penicillins for the Treatment of Methicillin-Sensitive<i>Staphylococcus aureus<\/i>Bacteremia"],"prefix":"10.1093","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3345-2655","authenticated-orcid":false,"given":"Elina Eleftheria","family":"Pliakos","sequence":"first","affiliation":[{"name":"Infectious Diseases Division, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5943-8635","authenticated-orcid":false,"given":"Panayiotis D","family":"Ziakas","sequence":"additional","affiliation":[{"name":"Infectious Diseases Division, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eleftherios","family":"Mylonakis","sequence":"additional","affiliation":[{"name":"Infectious Diseases Division, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2021,10,4]]},"reference":[{"key":"2021110405453105700_CIT0001","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1186\/s12941-016-0122-8","article-title":"Mortality predictors of Staphylococcus aureus bacteremia: a prospective multicenter study","volume":"15","author":"Yilmaz","year":"2016","journal-title":"Ann Clin Microbiol Antimicrob"},{"key":"2021110405453105700_CIT0002","doi-asserted-by":"crossref","first-page":"214","DOI":"10.15585\/mmwr.mm6809e1","article-title":"Vital signs: epidemiology and recent trends in methicillin-resistant and in methicillin-susceptible Staphylococcus aureus bloodstream infections\u2014United States","volume":"68","author":"Kourtis","year":"2019","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"2021110405453105700_CIT0003","doi-asserted-by":"crossref","first-page":"739","DOI":"10.1016\/j.ajic.2015.01.031","article-title":"Multicenter study of health care cost of patients admitted to hospital with Staphylococcus aureus bacteremia: impact of length of stay and intensity of care","volume":"43","author":"Thampi","year":"2015","journal-title":"Am J Infect Control"},{"key":"2021110405453105700_CIT0004","first-page":"22","article-title":"National costs associated with methicillin-susceptible and methicillin-resistant Staphylococcus aureus hospitalizations in the United States, 2010-2014","volume":"68","author":"Klein","year":"2019","journal-title":"Clin Infect Dis"},{"key":"2021110405453105700_CIT0005","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1007\/s00134-017-4683-6","article-title":"Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock: 2016","volume":"43","author":"Rhodes","year":"2017","journal-title":"Intensive Care Med"},{"key":"2021110405453105700_CIT0006","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1016\/j.ccc.2010.09.009","article-title":"Antibiotic de-escalation","volume":"27","author":"Masterton","year":"2011","journal-title":"Crit Care Clin"},{"key":"2021110405453105700_CIT0007","doi-asserted-by":"crossref","first-page":"5122","DOI":"10.1128\/AAC.00485-11","article-title":"Is cefazolin inferior to nafcillin for treatment of methicillin-susceptible Staphylococcus aureus bacteremia?","volume":"55","author":"Lee","year":"2011","journal-title":"Antimicrob Agents Chemother"},{"key":"2021110405453105700_CIT0008","doi-asserted-by":"crossref","first-page":"4684","DOI":"10.1128\/AAC.00243-16","article-title":"Cefazolin versus nafcillin for methicillin-sensitive Staphylococcus aureus bloodstream infection in a California tertiary medical center","volume":"60","author":"Pollett","year":"2016","journal-title":"Antimicrob Agents Chemother"},{"key":"2021110405453105700_CIT0009","doi-asserted-by":"crossref","first-page":"650","DOI":"10.1016\/j.ijantimicag.2016.12.021","article-title":"Implementation of a cefazolin-based stewardship pathway for methicillin-susceptible Staphylococcus aureus bloodstream infections paired with infectious diseases consultation","volume":"49","author":"Lee","year":"2017","journal-title":"Int J Antimicrob Agents"},{"key":"2021110405453105700_CIT0010","doi-asserted-by":"crossref","first-page":"5117","DOI":"10.1128\/AAC.02800-14","article-title":"Comparison of cefazolin versus oxacillin for treatment of complicated bacteremia caused by methicillin-susceptible Staphylococcus aureus","volume":"58","author":"Li","year":"2014","journal-title":"Antimicrob Agents Chemother"},{"key":"2021110405453105700_CIT0011","doi-asserted-by":"crossref","first-page":"1539","DOI":"10.1093\/jac\/dku560","article-title":"Comparative effectiveness of cefazolin versus cloxacillin as definitive antibiotic therapy for MSSA bacteraemia: results from a large multicentre cohort study","volume":"70","author":"Bai","year":"2015","journal-title":"J Antimicrob Chemother"},{"key":"2021110405453105700_CIT0012","doi-asserted-by":"crossref","first-page":"5232","DOI":"10.1128\/AAC.04677-14","article-title":"Treatment outcomes with cefazolin versus oxacillin for deep-seated methicillin-susceptible Staphylococcus aureus bloodstream infections","volume":"59","author":"Rao","year":"2015","journal-title":"Antimicrob Agents Chemother"},{"key":"2021110405453105700_CIT0013","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1007\/s40121-017-0148-z","article-title":"The safety and economic impact of cefazolin versus nafcillin for the treatment of methicillin-susceptible Staphylococcus aureus bloodstream infections","volume":"6","author":"Flynt","year":"2017","journal-title":"Infect Dis Ther"},{"key":"2021110405453105700_CIT0014","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1093\/cid\/cix287","article-title":"Comparative effectiveness of cefazolin versus nafcillin or oxacillin for treatment of methicillin-susceptible Staphylococcus aureus infections complicated by bacteremia: a nationwide cohort study","volume":"65","author":"McDanel","year":"2017","journal-title":"Clin Infect Dis"},{"key":"2021110405453105700_CIT0015","doi-asserted-by":"crossref","first-page":"508","DOI":"10.1186\/s12879-018-3418-9","article-title":"Efficacy and safety of cefazolin versus antistaphylococcal penicillins for the treatment of methicillin-susceptible Staphylococcus aureus bacteremia: a systematic review and meta-analysis","volume":"18","author":"Shi","year":"2018","journal-title":"BMC Infect Dis"},{"key":"2021110405453105700_CIT0016","doi-asserted-by":"crossref","first-page":"2643","DOI":"10.1093\/jac\/dky259","article-title":"Optimal treatment of MSSA bacteraemias: a meta-analysis of cefazolin versus antistaphylococcal penicillins","volume":"73","author":"Bidell","year":"2018","journal-title":"J Antimicrob Chemother"},{"key":"2021110405453105700_CIT0017","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1002\/jso.24331","article-title":"Importance of cost-effectiveness and value in cancer care and healthcare policy","volume":"114","author":"Kang","year":"2016","journal-title":"J Surg Oncol"},{"key":"2021110405453105700_CIT0018","doi-asserted-by":"crossref","first-page":"711","DOI":"10.1016\/j.outlook.2017.04.002","article-title":"Comparative and cost-effectiveness research: competencies, opportunities, and training for nurse scientists","volume":"65","author":"Stone","year":"2017","journal-title":"Nurs Outlook"},{"key":"2021110405453105700_CIT0019","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1016\/j.ijantimicag.2018.11.013","article-title":"Cefazolin vs. anti-staphylococcal penicillins for treatment of methicillin-susceptible Staphylococcus aureus bloodstream infections in acutely ill adult patients: results of a systematic review and meta-analysis","volume":"53","author":"Lee","year":"2019","journal-title":"Int J Antimicrob Agents"},{"key":"2021110405453105700_CIT0020","volume-title":"Cost-Effectiveness in Health and Medicine.","author":"Neumann","year":"2017"},{"key":"2021110405453105700_CIT0021","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1016\/j.cmi.2017.07.001","article-title":"Comparative outcomes of cefazolin versus nafcillin for methicillin-susceptible Staphylococcus aureus bacteraemia: a prospective multicentre cohort study in Korea","volume":"24","author":"Lee","year":"2018","journal-title":"Clin Microbiol Infect"},{"key":"2021110405453105700_CIT0022","doi-asserted-by":"crossref","first-page":"f1049","DOI":"10.1136\/bmj.f1049","article-title":"Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement","volume":"346","author":"Husereau","year":"2013","journal-title":"BMJ"},{"key":"2021110405453105700_CIT0023","doi-asserted-by":"crossref","first-page":"671","DOI":"10.1007\/s40121-019-00259-4","article-title":"Cefazolin versus anti-staphylococcal penicillins for the treatment of patients with methicillin-susceptible Staphylococcus aureus infection: a meta-analysis with trial sequential analysis","volume":"8","author":"Allen","year":"2019","journal-title":"Infect Dis Ther"},{"key":"2021110405453105700_CIT0024","doi-asserted-by":"crossref","first-page":"1258","DOI":"10.1111\/bcp.13554","article-title":"Meta-analysis of trials comparing cefazolin to antistaphylococcal penicillins in the treatment of methicillin-sensitive Staphylococcus aureus bacteraemia","volume":"84","author":"Rindone","year":"2018","journal-title":"Br J Clin Pharmacol"},{"key":"2021110405453105700_CIT0025","doi-asserted-by":"crossref","first-page":"486","DOI":"10.1016\/j.ijantimicag.2014.09.002","article-title":"Antistaphylococcal penicillins versus cephalosporins for definitive treatment of meticillin-susceptible Staphylococcus aureus bacteraemia: a systematic review and meta-analysis","volume":"44","author":"Vardakas","year":"2014","journal-title":"Int J Antimicrob Agents"},{"key":"2021110405453105700_CIT0026","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1016\/0197-2456(86)90046-2","article-title":"Meta-analysis in clinical trials","volume":"7","author":"DerSimonian","year":"1986","journal-title":"Control Clin Trials"},{"key":"2021110405453105700_CIT0027","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1016\/j.cct.2006.04.004","article-title":"Random-effects model for meta-analysis of clinical trials: an update","volume":"28","author":"DerSimonian","year":"2007","journal-title":"Contemp Clin Trials"},{"key":"2021110405453105700_CIT0028","volume-title":"CPI inflation calculator","author":"Bureau of Labor Statistics."},{"key":"2021110405453105700_CIT0029","year":"2021"},{"key":"2021110405453105700_CIT0030","author":"Fowler","year":"2021"},{"key":"2021110405453105700_CIT0031"},{"key":"2021110405453105700_CIT0032","doi-asserted-by":"crossref","first-page":"1271","DOI":"10.1378\/chest.122.4.1271","article-title":"Cost-effectiveness of IV-to-oral switch therapy: azithromycin vs cefuroxime with or without erythromycin for the treatment of community-acquired pneumonia","volume":"122","author":"Paladino","year":"2002","journal-title":"Chest"},{"key":"2021110405453105700_CIT0033","article-title":"State health facts: hospital adjusted expenses per inpatient day","author":"Kaiser Family Foundation.","year":"2018"},{"key":"2021110405453105700_CIT0034","author":"Statistics","year":"2021"},{"key":"2021110405453105700_CIT0035","doi-asserted-by":"crossref","first-page":"1377","DOI":"10.1345\/aph.1E028","article-title":"Clinical and economic analysis of methicillin-susceptible and -resistant Staphylococcus aureus infections","volume":"38","author":"Kopp","year":"2004","journal-title":"Ann Pharmacother"},{"key":"2021110405453105700_CIT0036","doi-asserted-by":"crossref","first-page":"297","DOI":"10.2165\/11584630-000000000-00000","article-title":"Sensitivity analysis in cost-effectiveness studies: from guidelines to practice","volume":"29","author":"Jain","year":"2011","journal-title":"Pharmacoeconomics"},{"key":"2021110405453105700_CIT0037","doi-asserted-by":"crossref","DOI":"10.1093\/oso\/9780198526629.001.0001","volume-title":"Decision Modelling for Health Economic Evaluation","author":"Briggs","year":"2006"},{"key":"2021110405453105700_CIT0038","doi-asserted-by":"crossref","first-page":"382","DOI":"10.1097\/CCM.0000000000000711","article-title":"Methicillin-resistant Staphylococcus aureus prevention strategies in the ICU: a clinical decision analysis","volume":"43","author":"Ziakas","year":"2015","journal-title":"Crit Care Med"},{"key":"2021110405453105700_CIT0039","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1186\/1471-2288-5-13","article-title":"Estimating the mean and variance from the median, range, and the size of a sample","volume":"5","author":"Hozo","year":"2005","journal-title":"BMC Med Res Methodol"},{"key":"2021110405453105700_CIT0040","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1177\/0272989X8500500205","article-title":"Probabilistic sensitivity analysis using Monte Carlo simulation. A practical approach","volume":"5","author":"Doubilet","year":"1985","journal-title":"Med Decis Making"},{"key":"2021110405453105700_CIT0041","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1002\/hec.903","article-title":"Cost-effectiveness acceptability curves\u2014facts, fallacies and frequently asked questions","volume":"13","author":"Fenwick","year":"2004","journal-title":"Health Econ"},{"key":"2021110405453105700_CIT0042","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1192\/bjp.187.2.106","article-title":"A guide to cost-effectiveness acceptability curves","volume":"187","author":"Fenwick","year":"2005","journal-title":"Br J Psychiatry"},{"key":"2021110405453105700_CIT0043","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1016\/j.jval.2016.12.005","article-title":"Toward a broader concept of value: identifying and defining elements for an expanded cost-effectiveness analysis","volume":"20","author":"Garrison","year":"2017","journal-title":"Value Health"},{"key":"2021110405453105700_CIT0044","doi-asserted-by":"crossref","DOI":"10.1128\/AAC.01816-17","article-title":"Systematic review and meta-analysis of the safety of antistaphylococcal penicillins compared to cefazolin","volume":"62","author":"Eljaaly","year":"2018","journal-title":"Antimicrob Agents Chemother"},{"key":"2021110405453105700_CIT0045","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1093\/cid\/ciu301","article-title":"Comparative evaluation of the tolerability of cefazolin and nafcillin for treatment of methicillin-susceptible Staphylococcus aureus infections in the outpatient setting","volume":"59","author":"Youngster","year":"2014","journal-title":"Clin Infect Dis"},{"key":"2021110405453105700_CIT0046","doi-asserted-by":"crossref","first-page":"2686","DOI":"10.1128\/AAC.40.12.2686","article-title":"Correlation of pharmacodynamic parameters of five beta-lactam antibiotics with therapeutic efficacies in an animal model","volume":"40","author":"Soriano","year":"1996","journal-title":"Antimicrob Agents Chemother"},{"key":"2021110405453105700_CIT0047","doi-asserted-by":"crossref","DOI":"10.1128\/CMR.00095-17","article-title":"The cost-effectiveness of rapid diagnostic testing for the diagnosis of bloodstream infections with or without antimicrobial stewardship","volume":"31","author":"Pliakos","year":"2018","journal-title":"Clin Microbiol Rev"},{"key":"2021110405453105700_CIT0048","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1093\/cid\/ciy511","article-title":"The cost-effectiveness of antimicrobial lock solutions for the prevention of central line-associated bloodstream infections","volume":"68","author":"Pliakos","year":"2019","journal-title":"Clin Infect Dis"},{"key":"2021110405453105700_CIT0049","doi-asserted-by":"crossref","first-page":"787","DOI":"10.1016\/j.chest.2018.11.001","article-title":"The cost-effectiveness of corticosteroids for the treatment of community-acquired pneumonia","volume":"155","author":"Pliakos","year":"2019","journal-title":"Chest"},{"key":"2021110405453105700_CIT0050","author":"Health Catalyst","year":"2017"},{"key":"2021110405453105700_CIT0051","doi-asserted-by":"crossref","first-page":"1194","DOI":"10.1086\/379021","article-title":"Relapse of type A beta-lactamase-producing Staphylococcus aureus native valve endocarditis during cefazolin therapy: revisiting the issue","volume":"37","author":"Nannini","year":"2003","journal-title":"Clin Infect Dis"},{"key":"2021110405453105700_CIT0052","doi-asserted-by":"crossref","first-page":"3437","DOI":"10.1128\/AAC.00317-09","article-title":"Inoculum effect with cefazolin among clinical isolates of methicillin-susceptible Staphylococcus aureus: frequency and possible cause of cefazolin treatment failure","volume":"53","author":"Nannini","year":"2009","journal-title":"Antimicrob Agents Chemother"},{"key":"2021110405453105700_CIT0053","author":"CDC","year":"2019"},{"key":"2021110405453105700_CIT0054","doi-asserted-by":"crossref","first-page":"1366","DOI":"10.1377\/hlthaff.26.5.1366","article-title":"\u2018Redefining health care\u2019: medical homes or archipelagos to navigate?","volume":"26","author":"Enthoven","year":"2007","journal-title":"Health Aff (Millwood)"},{"key":"2021110405453105700_CIT0055","doi-asserted-by":"crossref","first-page":"2477","DOI":"10.1056\/NEJMp1011024","article-title":"What is value in health care?","volume":"363","author":"Porter","year":"2010","journal-title":"N Engl J Med"},{"key":"2021110405453105700_CIT0056","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1093\/cid\/cix288","article-title":"Definitive treatment for methicillin-susceptible Staphylococcus aureus bacteremia: data versus a definitive answer?","volume":"65","author":"Karchmer","year":"2017","journal-title":"Clin Infect Dis"}],"container-title":["Open Forum Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/ofid\/advance-article-pdf\/doi\/10.1093\/ofid\/ofab476\/40544184\/ofab476.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/ofid\/article-pdf\/8\/11\/ofab476\/41074718\/ofab476.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/ofid\/article-pdf\/8\/11\/ofab476\/41074718\/ofab476.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,9]],"date-time":"2023-11-09T22:44:42Z","timestamp":1699569882000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ofid\/article\/doi\/10.1093\/ofid\/ofab476\/6380656"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,10,4]]},"references-count":56,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2021,11,1]]}},"URL":"https:\/\/doi.org\/10.1093\/ofid\/ofab476","relation":{},"ISSN":["2328-8957"],"issn-type":[{"value":"2328-8957","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2021,11,1]]},"published":{"date-parts":[[2021,10,4]]},"article-number":"ofab476"}}