Cost-effectiveness Comparison of Ceftazidime/Avibactam Versus Meropenem in the Empirical Treatment of Hospital-acquired Pneumonia, Including Ventilator-associated Pneumonia, in Italy

Abstract

Purpose: Ceftazidime/avibactam (CAZ-AVI) is a fixed-dose combination antibiotic approved in Europe and the United States for patients with hospitalacquired pneumonia, including ventilator-associated pneumonia (HAP/VAP). The economic benefits of a new drug such as CAZ-AVI are required to be assessed against those of available comparators, from the perspective of health care providers and payers, through cost-effectiveness and cost-utility analyses. The objective of this analysis was to compare the cost-effectiveness of CAZ-AVI versus meropenem in the empirical treatment of appropriate hospitalized patients with HAP/VAP caused by gram-negative pathogens, from the perspective of publicly funded health care in Italy (third-party perspective, based on the data from the REPROVE (Ceftazidime-Avibactam Versus Meropenem In Nosocomial Pneumonia, Including Ventilator-Associated Pneumonia) clinical study; ClinicalTrials.gov NCT01808092). Methods: A patient-level, sequential simulation model of the HAP/VAP clinical course was developed using spreadsheet software. The analysis focused on direct medical costs. The time horizon of the model selected was 5 years, with an annual discount rate of 3% on costs and quality-adjusted life-years (QALYs). Clinical inputs for treatment comparisons were mainly obtained from the REPROVE clinical study data. In addition to clinical outcomes observed in the trial, the model incorporated impact of resistance pathogens, based on data from published studies and expert opinion. Certain assumptions were made for some model parameters due to a lack of data. Findings: The analysis demonstrated that the intervention sequence (CAZ-AVI followed by colistin + high-dose meropenem) versus the comparator sequence (meropenem followed by colistin + high-dose meropenem) provided a better clinical cure rate (+13.52%), which led to a shorter hospital stay (−0.40 days per patient), and gains in the number of life-years (+0.195) and QALYs (+0.350) per patient. The intervention sequence had an estimated net incremental total cost of V1254 ($1401) per patient, and the estimated incremental cost-effectiveness ratio was V3581

Best practices: Appropriate use of the new β-lactam/β-lactamase inhibitor combinations, ceftazidime-avibactam and ceftolozane-tazobactam in South Africa

“…These studies found that CA was cost-effective for CRE-BSIs and -pneumonia based on accepted willingness topay-standards in both the United States (US) and Italy. 52,53 Similar conclusions were reached for low-to middle-income countries for CA versus colistin for CRE-BSIs and pneumonia in Peru. 54 Particularly relevant to South Africa, recent reports have focused on the role of CA in OXA-48-producing bacteria.…”

“…51 Ceftazidime-avibactam also has more favourable PK characteristics than colistin and has been shown to be better tolerated and several positive cost-effectiveness analyses have also been reported for BSIs, HAP and VAP. 52,53 Outcomes evaluated included quality-adjusted life-years, healthcare costs and incremental cost-effectiveness ratios. These studies found that CA was cost-effective for CRE-BSIs and -pneumonia based on accepted willingness topay-standards in both the United States (US) and Italy.…”

Choosing Optimal Antibiotics for the Treatment of Patients Infected With Enterobacteriaceae: A Network Meta-analysis and Cost-Effectiveness Analysis

“…Our study only analyzed the cost-effectiveness of ceftazidime/avibactam in patients with cUTI, because antibiotics related to cIAI treatment cannot form a closed loop. Similarly, studies have been performed for bacteremia, cIAI, and hospital-acquired pneumonia/ventilator acquired pneumonia (Kongnakorn et al, 2019b;Simon et al, 2019;Tichy et al, 2020), and the pharmacoeconomics results of ceftazidime/avibactam were all favorable in these studies. The economic effects of ceftazidime/avibactam for different types of infection require more researches to confirm.…”

Análise de custos da prevenção da pneumonia associada a ventilação mecânica: uma revisão integrativa

“…Considerando que os dados da OPAS (2020) revelam os gastos com saúde como sendo os maiores dentre todos os gastos estatais e permanecem com tendência de crescimento acelerado, levando em consideração que, nos dias atuais, esses gastos representam 10% do Produto Interno Bruto (PIB) mundial. No Brasil ele é de 8%, sendo 4,4% em gastos privados (55% do total) e 3,8% PIB são com gastos públicos (45% do total).…”

“…Da mesma forma o estudiosoVaron (2014), analisou o custo-efetividade comparando medicações estimando a eficácia da linezolina no custo da vancomicina associada a PAV por Staphylococcus aureus resistente à meticilina na Colombia, foi possível obter como resultado que na Colombia a Linezolina seria uma alternativa custoefetiva no tratamento da PAV, pela disposição de pagar mais de UU$ 5.061.173 por paciente curado.Por fim, ao realizarem um estudo de custo-efetividade para comparar o custoefetividade do CAZ-AVI versus meropenem no tratamento empírico de pacientes hospitalizados apropriados com HAP/PAV, causada por patógenos gram-negativos, sob a perspectiva de cuidados de saúde financiados publicamente na Itália, Eszter et al(2020), trazem os resultados do modelo mostrando que se espera que o CAZ-AVI forneça benefícios clínicos em pacientes hospitalizados com HAP/PAV na Itália a um custo aceitável em comparação com o meropenem.…”