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Cost-effectiveness analysis of ceftazidime/avibactam compared to imipenem as empirical treatment for complicated urinary tract infections.
Int J Antimicrob Agents. 2019 Jun 13;:
Authors: Kongnakorn T, Wagenlehner F, Falcone M, Tichy E, Di Virgilio R, Baillon-Plot N, Charbonneau C
Abstract
Ceftazidime/avibactam (CAZ-AVI) is a novel, fixed-dose combination antibiotic that has been approved in Europe and the United States for patients with complicated urinary tract infections (cUTIs), based on results of a Phase III, randomized, comparative study (RECAPTURE study). The present analysis evaluated cost-effectiveness of CAZ-AVI as an empiric treatment for hospitalized patients with cUTIs from the Italian publicly funded healthcare (third-party payer) perspective. A sequential, patient-level simulation model that followed the clinical course of cUTI and generated pairs of identical 5,000 patients (CAZ-AVI or imipenem as empiric treatment) was developed. The model included additional impact of resistant pathogens; patients who did not respond to empiric treatment were switched to second-line treatment of colistin+high dose carbapenem in both groups. The time horizon of the model was five years with an annual discount rate of 3% applied to both costs and quality-adjusted life-years (QALYs). The analysis demonstrated that intervention sequence (CAZ-AVI followed by colistin+high dose carbapenem) compared to comparator sequence (imipenem followed by colistin+high dose carbapenem) although at a net incremental cost of € 1,015 per patient, provided better health outcomes in terms of clinical cure (97.65% versus 91.08%; ∆=6.57%), shorter hospital stays (10.65 versus 12.55 days; ∆=1.90 days), and QALYs gained per patient (4.190 versus 4.063; ∆=0.126). The incremental cost-effectiveness ratio was € 8,039/QALY which is well below the willingness-to-pay threshold of € 30,000/QALY in Italy. The model results showed that CAZ-AVI is expected to be a cost-effective treatment compared to imipenem for cUTI in Italy.
PMID: 31202921 [PubMed - as supplied by publisher]