JULY 2011
Report Authors
Danielle L. Drayton, Ph.D.
Introduction:
Nosocomial pneumonia is an important segment of the hospital antibiotics market because of the high morbidity and mortality of this infection, limited treatment options, and the increasing incidence of multidrug-resistant pathogens including Pseudomonas aeruginosa, Acinetobacter species, ESBL-producing Enterobacteriaceae, and methicillin-resistant Staphylococcus aureus (MRSA). Broad-spectrum therapies (e.g., cephalosporins, beta-lactam/beta-lactamase inhibitors, and carbapenems) are a mainstay in the management of NP, though use of these antibiotic classes is highly variable across the United States and Europe. The uptake of narrow-spectrum anti-MRSA therapies, namely vancomycin and Pfizer’s Zyvox [linezolid] has been a key driver of market growth as the concern regarding NP due to MRSA has grown. An important driver of market growth is the heavy reliance on empiric therapy to manage NP. Moreover, empiric coverage of MRSA and multi-drug resistant gram-negative pathogens will likely be a key driver of the uptake of novel agents, currently marketed narrow-spectrum MRSA agents, and antibiotics often used in later lines of therapy (e.g., carbapenems).
Using clinical audit data from the Arlington Medical Resources, LLC (AMR) Hospital Antibiotic Market Guide (HAMG), as well as insight from surveys of 100 U.S.-based infectious disease specialists, we examine the patient population, prescribers, products and the treatment of NP, including the following:
- Patient Population Analysis: This section provides patient population segmentation by gender, age-group, hospital demographics, type of HAP (early- versus late-onset disease), hospitalization outcomes, co-morbidities, and risk factors.
- Pathogen Analysis: This section quantifies both the rate of pathogen identification in NP patients and the at-risk population for infection due to key pathogens in NP, provides information on frequency of multidrug-resistant isolates of key gram-negative pathogens in NP, evaluates the frequency of key gram-negative pathogens (e.g., P. aeruginosa, Acinetobacter, E. coli, K. pneumoniae) and gram-positive pathogens (e.g., S. pneumoniae, MRSA, MSSA) in NP and how the percentage of patients infected with these pathogens has changed over the last five years.
- Prescriber Analysis: This section details the key prescribers in NP, their patterns of antibiotic usage, and trends in physician prescribing for NP (e.g., which physicians are increasingly involved in the treatment of NP and which are less involved). This section also quantifies the proportion of the NP patient population who require an consultation with an infectious disease physician as part of treatment.
- Treatment Analysis and Physician Insight: This section details drug class share, antibiotic patient share by line of therapy, physician insight on the hospital treatment guidelines for NP, physician-preferred treatment by pathogen and intent, rates of treatment failure by drug and pathogen, and how physicians are managing the treatment of gram-negative and gram-positive pathogens in NP.
- Product Analysis: This section includes a detailed overview of product usage; trends in product patient share and days of therapy; product usage by line of therapy, intent, and physician specialty; and discharge therapy analysis.
Questions Answered
* NP patients are generally older, suffer from numerous comorbidities that complicate treatment, have factors that put them at risk of infection, and often require extended hospitalization.
What percentage of NP patients suffer from hepatic or renal impairment? What is the average length of hospitalization and average duration of antibiotic treatment for NP patients? What percentage of NP patients are mechanically ventilated or are admitted to the ICU? What are patient treatment outcomes (e.g., mortality rate, percentage of patient discharged home) and how do comorbid conditions, mechanical ventilation, and ICU stay affect treatment outcomes?
* Because of the low rate of pathogen identification in NP, physicians frequently rely on treatment guidelines, patient history, timing of disease onset, and local hospital epidemiology to guide their treatment decisions.
In what percentage of NP patients is a pathogen identified and what percentage of NP patients is treated empirically? What are physicians’ preferred empiric therapy for late-onset HAP, early onset-HAP, HCAP, and VAP? What percentage of patients do physicians suspect are at risk of infection due to MRSA, P. aeruginosa, Acinetobacter species, or ESBL-producing Enterobacteriaceae? What treatment options do clinicians prefer in patients with documented infection due to these pathogens?
* MRSA has emerged as a key etiologic pathogen in NP and continues to be a challenge for which few effective treatment options are available.
What drug attributes are most important in physician selection of a treatment for HAP proven to be caused by MRSA? What therapy do clinicians preferred to empiric treatment of HAP and the treatment of HAP proven to be due to MRSA? What is the treatment failure rate of anti-MRSA antibiotics including vancomycin and linezolid?
* A broad range of antibiotics are used to treat NP, including agents with broad- and narrow-spectrum activity.
What are the most frequently prescribed products for NP across the United States and Europe and how has their use (e.g., days of therapy, patient share) changed over the last five years? How are key products used by line of therapy and treatment intent (empiric versus treatment of a confirmed/documented pathogen). Who are the key prescribers of individual products and with which prescribers has product usage increased or declined over the last year? What percentage of NP patients is discharged on treatment and what are the top discharge therapies by country?
Scope
Markets covered: United States, France, Germany, Italy, Spain, United Kingdom.
Primary research: Online survey of 101 U.S.-based infectious disease specialists.
Products with detailed analysis:
- Levofloxacin IV and PO – Johnson & Johnson’s Levaquin
- Doripenem – Johnson & Johnson’s Doribax
- Ertapenem – Merck’s Invanz
- Meropenem – AstraZeneca’s Merrem
- Imipenem/cilastatin – Merck’s Primaxin
- Piperacillin/tazobactam – Pfizer’s Zosyn, generics
- Tigecycline – Pfizer’s Tygacil
- Ceftazidiime – generics
- Ceftriaxone – generics
- Linezolid IV and PO – Pfizer’s Zyvox
- Vancomycin – generics
- Moxifloxacin – Merck/Bayer’s Avelox