How much is a life worth? Food for thought.

TO THE EDITOR—We read with great interest the recently published observational study by Murray et al [1]. This study presents data that daptomycin (compared to vancomycin) is associated with a survival advantage in patients hospitalized with methicillin-resistant Staphylococcus aureus bacteremia. They report a decreased in-hospital mortality rate in those treated with daptomycin compared to vancomycin, 3.5% versus 11.9%, P = .047. This would translate into a number needed to treat of 11.9 to save 1 life in patients treated with daptomycin compared to vancomycin. Based on the data, they reported that the marginal cost associated with this would be $8740 per patient, the difference in mean hospital charge in patients treated with daptomycin compared to vancomycin (reported P = .64). Thus, to save 1 life (potential biases of the study aside), based on Murray et al’s data, we estimate the cost would be approximately $104 006 (or 11.9 × $8740). Given that the true hospital cost is often lower than the associated hospital charge, we expect this may be an overestimate of the true hospital cost. Hospitals are under are under substantial (sometimes enormous) cost pressures, and it can be difficult to balance antimicrobial budgets and maximize patient outcomes. In this context, we believe the above estimate of the cost to save 1 life provides important food for thought: How much is one life worth? In addition, how does this amount compare to other costly medical interventions associated with potential benefits on mortality? Although the discussed study was observational in nature, with significant potential biases, we believe these concerns reinforce the need for further clinical trials to definitively address these issues.