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Cost-effectiveness analysis of ceftazidime/avibactam compared to imipenem as empirical treatment for complicated urinary tract infections.

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 empirical treatment for hospitalized patients with cUTIs from the Italian publicly funded healthcare (third-party payer) perspective. A sequential, patient-level simulation model was developed that followed the clinical course of cUTI and generated 5000 pairs of identical patients (CAZ-AVI or imipenem as empirical treatment). The model included additional impact of resistant pathogens; patients who did not respond to empirical 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 an intervention sequence (CAZ-AVI followed by colistin+high dose carbapenem) compared with a comparator sequence (imipenem followed by colistin+high dose carbapenem) was associated with a net incremental cost of €1015 per patient but provided better health outcomes in terms of clinical cure (97.65% vs. 91.08%; ∆ = 6.57%), shorter hospital stays (10.65 vs. 12.55 days; ∆ = 1.90 days), and QALYs gained per patient (4.190 vs. 4.063; ∆ = 0.126). The incremental cost-effectiveness ratio was €8039/QALY, which is well below the willingness-to-pay threshold of €30 000/QALY in Italy. The results showed that CAZ-AVI is expected to be a cost-effective treatment compared with imipenem for cUTI in Italy.

Authors+Show Affiliations

Evidera, The Ark, 2nd Floor, 201 Talgarth Road, London, W6 8BJ, United Kingdom. Electronic address: thitima/kongnakorn@evidera.com.Justus-Liebig-University, Clinic of Urology, Pediatric Urology and Andrology, Rudolf-Buchheim-Str 7; D-35392, Giessen, Germany. Electronic address: florian.wagenlehner@chiru.med.uni-giessen.de.Department of Clinical and Experimental Medicine, University of Pisa, Lungarno Pacinotti 43, 56126, Pisa, Italy. Electronic address: marco.falcone@uniroma1.it.Evidera, Bég u. 3-5 / 520, 1022 Budapest, Hungary. Electronic address: eszter.tichy@evidera.com.Pfizer, Via Valbondione, 113, 00188 Roma RM, Italy. Electronic address: roberto.divirgilio@pfizer.com.Pfizer, 23-25 Avenue du Dr Lannelongue, 75014, Paris, France. Electronic address: nathalie.baillon-plot@pfizer.com.Pfizer, 23-25 Avenue du Dr Lannelongue, 75014, Paris, France. Electronic address: Claudie.Charbonneau@pfizer.com.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31202921

Citation

Kongnakorn, Thitima, et al. "Cost-effectiveness Analysis of Ceftazidime/avibactam Compared to Imipenem as Empirical Treatment for Complicated Urinary Tract Infections." International Journal of Antimicrobial Agents, 2019.
Kongnakorn T, Wagenlehner F, Falcone M, et al. Cost-effectiveness analysis of ceftazidime/avibactam compared to imipenem as empirical treatment for complicated urinary tract infections. Int J Antimicrob Agents. 2019.
Kongnakorn, T., Wagenlehner, F., Falcone, M., Tichy, E., Di Virgilio, R., Baillon-Plot, N., & Charbonneau, C. (2019). Cost-effectiveness analysis of ceftazidime/avibactam compared to imipenem as empirical treatment for complicated urinary tract infections. International Journal of Antimicrobial Agents, doi:10.1016/j.ijantimicag.2019.06.008.
Kongnakorn T, et al. Cost-effectiveness Analysis of Ceftazidime/avibactam Compared to Imipenem as Empirical Treatment for Complicated Urinary Tract Infections. Int J Antimicrob Agents. 2019 Jun 13; PubMed PMID: 31202921.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cost-effectiveness analysis of ceftazidime/avibactam compared to imipenem as empirical treatment for complicated urinary tract infections. AU - Kongnakorn,Thitima, AU - Wagenlehner,Florian, AU - Falcone,Marco, AU - Tichy,Eszter, AU - Di Virgilio,Roberto, AU - Baillon-Plot,Nathalie, AU - Charbonneau,Claudie, Y1 - 2019/06/13/ PY - 2018/11/02/received PY - 2019/06/07/revised PY - 2019/06/10/accepted PY - 2019/6/17/pubmed PY - 2019/6/17/medline PY - 2019/6/17/entrez KW - CAZ-AVI (or ceftazidime/avibactam) KW - Cost-effective analysis KW - Economic evaluation KW - RECAPTURE KW - Resistance KW - UTI (or urinary tract infection) JF - International journal of antimicrobial agents JO - Int. J. Antimicrob. Agents N2 - 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 empirical treatment for hospitalized patients with cUTIs from the Italian publicly funded healthcare (third-party payer) perspective. A sequential, patient-level simulation model was developed that followed the clinical course of cUTI and generated 5000 pairs of identical patients (CAZ-AVI or imipenem as empirical treatment). The model included additional impact of resistant pathogens; patients who did not respond to empirical 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 an intervention sequence (CAZ-AVI followed by colistin+high dose carbapenem) compared with a comparator sequence (imipenem followed by colistin+high dose carbapenem) was associated with a net incremental cost of €1015 per patient but provided better health outcomes in terms of clinical cure (97.65% vs. 91.08%; ∆ = 6.57%), shorter hospital stays (10.65 vs. 12.55 days; ∆ = 1.90 days), and QALYs gained per patient (4.190 vs. 4.063; ∆ = 0.126). The incremental cost-effectiveness ratio was €8039/QALY, which is well below the willingness-to-pay threshold of €30 000/QALY in Italy. The results showed that CAZ-AVI is expected to be a cost-effective treatment compared with imipenem for cUTI in Italy. SN - 1872-7913 UR - https://www.unboundmedicine.com/medline/citation/31202921/Cost-effectiveness_analysis_of_ceftazidime/avibactam_compared_to_imipenem_as_empirical_treatment_for_complicated_urinary_tract_infections L2 - https://linkinghub.elsevier.com/retrieve/pii/S0924-8579(19)30161-X DB - PRIME DP - Unbound Medicine ER -