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Cost-effectiveness analysis comparing ceftazidime/avibactam (CAZ-AVI) as empirical treatment comparing to ceftolozane/tazobactam and to meropenem for complicated intra-abdominal infection (cIAI).

Abstract

Background

The rising incidence of resistance to currently available antibiotics among pathogens, particularly Gram-negative pathogens, in complicated intra-abdominal infections (cIAIs) has become a challenge for clinicians. Ceftazidime/avibactam (CAZ-AVI) is a fixed-dose antibiotic approved in Europe and the United States for treating (in combination with metronidazole) cIAI in adult hospitalised patients who have limited or no alternative treatment options. The approval was based on the results of RECLAIM, a Phase III, parallel-group, comparative study (RECLAIM 1 [NCT01499290] and RECLAIM 2 [NCT01500239]). The objective of our study was to assess the cost-effectiveness of CAZ-AVI plus metronidazole compared with 1) ceftolozane/tazobactam plus metronidazole and 2) meropenem, as an empiric treatment for the management of cIAI in Italy.

Methods

A sequential, patient-level simulation model, with a 5-year time horizon and 3% annual discount rate (applied to both costs and health benefits), was developed using Microsoft Excel® to demonstrate the clinical course of the disease. The impact of resistant pathogens was included as an additional factor.

Results

In the base-case analysis, the CAZ-AVI sequence (CAZ-AVI plus metronidazole followed by a colistin + tigecycline + high-dose meropenem combination after treatment failure), when compared to sequences for ceftolozane/tazobactam (ceftolozane/tazobactam plus metronidazole followed by colistin + tigecycline + high-dose meropenem after treatment failure) and meropenem (meropenem followed by colistin + tigecycline + high-dose meropenem after treatment failure), had better clinical outcomes with higher cure rates (93.04% vs. 91.52%; 92.98% vs. 90.24%, respectively), shorter hospital stays (∆ = - 0.38 and ∆ = - 1.24 days per patient, respectively), and higher quality-adjusted life years (QALYs) gained per patient (4.021 vs. 3.982; 4.019 vs. 3.960, respectively). The incremental cost effectiveness ratio in the CAZ-AVI sequence was €4099 and €15,574 per QALY gained versus each comparator sequence, respectively, well below the willingness-to-pay threshold of €30,000 per QALY accepted in Italy.

Conclusions

The model results demonstrated that CAZ-AVI plus metronidazole could be a cost-effective alternative when compared with other antibiotic treatment options, as it is expected to provide better clinical benefits in hospitalised patients with cIAI in Italy.

Authors+Show Affiliations

Evidera, The Ark, 201 Talgarth Road, Hammersmith, London W6 8BJ UK.2Klinikum Peine, Academic Hospital of Medical University Hannover, Hannover, Germany.3Infectious Diseases Clinic, Department of Health Sciences, University of Genoa, Genoa and Hospital Policlinico San Martino IRCCS, Genoa, Italy.Evidera, Bég u. 3-5 / 520, Budapest, 1022 Hungary.5Pfizer, Via Valbondione, 113, 00188 Rome, Italy.6Pfizer, 23-25 Avenue du Dr Lannelongue, 75014 Paris, France.6Pfizer, 23-25 Avenue du Dr Lannelongue, 75014 Paris, France.

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

31890160

Citation

Kongnakorn, Thitima, et al. "Cost-effectiveness Analysis Comparing Ceftazidime/avibactam (CAZ-AVI) as Empirical Treatment Comparing to Ceftolozane/tazobactam and to Meropenem for Complicated Intra-abdominal Infection (cIAI)." Antimicrobial Resistance and Infection Control, vol. 8, 2019, p. 204.
Kongnakorn T, Eckmann C, Bassetti M, et al. Cost-effectiveness analysis comparing ceftazidime/avibactam (CAZ-AVI) as empirical treatment comparing to ceftolozane/tazobactam and to meropenem for complicated intra-abdominal infection (cIAI). Antimicrob Resist Infect Control. 2019;8:204.
Kongnakorn, T., Eckmann, C., Bassetti, M., Tichy, E., Di Virgilio, R., Baillon-Plot, N., & Charbonneau, C. (2019). Cost-effectiveness analysis comparing ceftazidime/avibactam (CAZ-AVI) as empirical treatment comparing to ceftolozane/tazobactam and to meropenem for complicated intra-abdominal infection (cIAI). Antimicrobial Resistance and Infection Control, 8, 204. https://doi.org/10.1186/s13756-019-0652-x
Kongnakorn T, et al. Cost-effectiveness Analysis Comparing Ceftazidime/avibactam (CAZ-AVI) as Empirical Treatment Comparing to Ceftolozane/tazobactam and to Meropenem for Complicated Intra-abdominal Infection (cIAI). Antimicrob Resist Infect Control. 2019;8:204. PubMed PMID: 31890160.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cost-effectiveness analysis comparing ceftazidime/avibactam (CAZ-AVI) as empirical treatment comparing to ceftolozane/tazobactam and to meropenem for complicated intra-abdominal infection (cIAI). AU - Kongnakorn,Thitima, AU - Eckmann,Christian, AU - Bassetti,Matteo, AU - Tichy,Eszter, AU - Di Virgilio,Roberto, AU - Baillon-Plot,Nathalie, AU - Charbonneau,Claudie, Y1 - 2019/12/21/ PY - 2019/09/06/received PY - 2019/11/13/accepted PY - 2020/1/1/entrez PY - 2020/1/1/pubmed PY - 2020/7/18/medline KW - Ceftazidime-avibactam plus metronidazole KW - Ceftolozane/tazobactam plus metronidazole KW - Complicated intra-abdominal infection KW - Cost-effectiveness analysis KW - Economic model KW - Meropenem SP - 204 EP - 204 JF - Antimicrobial resistance and infection control JO - Antimicrob Resist Infect Control VL - 8 N2 - Background: The rising incidence of resistance to currently available antibiotics among pathogens, particularly Gram-negative pathogens, in complicated intra-abdominal infections (cIAIs) has become a challenge for clinicians. Ceftazidime/avibactam (CAZ-AVI) is a fixed-dose antibiotic approved in Europe and the United States for treating (in combination with metronidazole) cIAI in adult hospitalised patients who have limited or no alternative treatment options. The approval was based on the results of RECLAIM, a Phase III, parallel-group, comparative study (RECLAIM 1 [NCT01499290] and RECLAIM 2 [NCT01500239]). The objective of our study was to assess the cost-effectiveness of CAZ-AVI plus metronidazole compared with 1) ceftolozane/tazobactam plus metronidazole and 2) meropenem, as an empiric treatment for the management of cIAI in Italy. Methods: A sequential, patient-level simulation model, with a 5-year time horizon and 3% annual discount rate (applied to both costs and health benefits), was developed using Microsoft Excel® to demonstrate the clinical course of the disease. The impact of resistant pathogens was included as an additional factor. Results: In the base-case analysis, the CAZ-AVI sequence (CAZ-AVI plus metronidazole followed by a colistin + tigecycline + high-dose meropenem combination after treatment failure), when compared to sequences for ceftolozane/tazobactam (ceftolozane/tazobactam plus metronidazole followed by colistin + tigecycline + high-dose meropenem after treatment failure) and meropenem (meropenem followed by colistin + tigecycline + high-dose meropenem after treatment failure), had better clinical outcomes with higher cure rates (93.04% vs. 91.52%; 92.98% vs. 90.24%, respectively), shorter hospital stays (∆ = - 0.38 and ∆ = - 1.24 days per patient, respectively), and higher quality-adjusted life years (QALYs) gained per patient (4.021 vs. 3.982; 4.019 vs. 3.960, respectively). The incremental cost effectiveness ratio in the CAZ-AVI sequence was €4099 and €15,574 per QALY gained versus each comparator sequence, respectively, well below the willingness-to-pay threshold of €30,000 per QALY accepted in Italy. Conclusions: The model results demonstrated that CAZ-AVI plus metronidazole could be a cost-effective alternative when compared with other antibiotic treatment options, as it is expected to provide better clinical benefits in hospitalised patients with cIAI in Italy. SN - 2047-2994 UR - https://www.unboundmedicine.com/medline/citation/31890160/Cost_effectiveness_analysis_comparing_ceftazidime/avibactam__CAZ_AVI__as_empirical_treatment_comparing_to_ceftolozane/tazobactam_and_to_meropenem_for_complicated_intra_abdominal_infection__cIAI__ L2 - https://aricjournal.biomedcentral.com/articles/10.1186/s13756-019-0652-x DB - PRIME DP - Unbound Medicine ER -