Cost-utility analysis of ceftolozane/tazobactam vs meropenem in patients with hospital-acquired pneumonia (HABP) or ventilator-associated pneumonia (VABP)
DOI:
https://doi.org/10.33393/grhta.2022.2287Keywords:
Antibiotic Resistance;, Antibiotic, Cost-effectiveness analysis, Cost-utility analysis, Nosocomial infectionsAbstract
Objective: This study aims to evaluate the cost-effectiveness of ceftolozane/tazobactam compared to meropenem for the treatment of patients with hospital-acquired pneumonia (HABP) or ventilator-associated pneumonia (VABP) from the Italian National Health Service (NHS) and social perspective.
Method: A decision tree and a Markov model were developed in order to forecast long-term and short-term disease effects respectively. A hypothetical target population of 1,000 HABP/VABP patients was followed for a lifetime time horizon. In the short-term decision tree, two different settings were developed in order to evaluate the value of empirical therapy compared with the start of treatment after confirmation of the antibiogram. Treated and cured patients enter the long-term Markov model following the mortality of the general population. Direct and indirect costs were considered accordingly with the analysis perspective.
Results: The analysis showed that ceftolozane/tazobactam, in both treatment settings (empirical and confirmed), may be a cost-effective option compared to meropenem from the NHS and social perspective (ICER equal to € 1,913 and € 2,203 in the empirical treatment setting and € 6,163 and € 6,597 in the confirmed treatment setting for NHS and social perspective respectively).
Conclusions: Introduction of ceftolozane/tazobactam within the Italian healthcare context can represent a valid therapeutic solution both from an economic and an efficacy profile point of view.
Downloads
References
Regione autonoma Friuli Venezia Giulia. Linee Guida Regionali per la Gestione delle Polmoniti Batteriche. Online: https://arcs.sanita.fvg.it/media/uploads/2020/05/15/09122014_LG_polmoniti_batt_ott_14_.pdf (Accessed June 2021)
Ten threats to global health in 2019. https://www.who.int/emergencies/ten-threats-toglobal-health-in-2019
Talbot GH, Das A, Cush S, et al; Foundation for the National Institutes of Health Biomarkers Consortium HABP/VABP Project Team. Evidence-Based Study Design for Hospital-Acquired Bacterial Pneumonia and Ventilator-Associated Bacterial Pneumonia. J Infect Dis. 2019;219(10):1536-1544. https://doi.org/10.1093/infdis/jiy578 PMID:30649434 DOI: https://doi.org/10.1093/infdis/jiy578
Inchai J, Pothirat C, Liwsrisakun C, Deesomchok A, Kositsakulchai W, Chalermpanchai N. Ventilator-associated pneumonia: epidemiology and prognostic indicators of 30-day mortality. Jpn J Infect Dis. 2015;68(3):181-186. https://doi.org/10.7883/yoken.JJID.2014.282 PMID:25672347 DOI: https://doi.org/10.7883/yoken.JJID.2014.282
Davis J, Finley E. The breadth of Hospital-Acquired Pneumonia: Nonventilated versus Ventilated Patients in Pennsylvania. Pa Patient Saf Advis. 2012;9(3):99-105.
Sun D, Moorthy V, Chang S-C, et al. Economic Burden of Ventilator-Associated, Hospital-Acquired, Healthcare-Associated and Community-Acquired Pneumonia in the Hospital Setting. Open Forum Infect Dis. 2016;3(suppl 1):1494. Accessed June, 2021. https://doi.org/10.1093/ofid/ofw172.1196 DOI: https://doi.org/10.1093/ofid/ofw172.1196
De Angelis G et al. Burden of Antibiotic Resistant Gram Negative Bacterial Infections: evidence and Limits. J Med Microbiol Diagn. 2014;3:1-6.
Cubist Pharmaceuticals LLC. A prospective, randomized, double-blind, multicenter, Phase 3 study to assess the safety and efficacy of intravenous ceftolozano/tazobactam compared with meropenem in adult patients with Ventilated Nosocomial Pneumonia. (Clinical Study Report: P008MK7625A) 17 October 2018.
Fattore G. Proposta di Linee-Guida per la valutazione economica degli interventi sanitari. PharmacoEcon Ital Res Artic. 2009;11(2):83-93. https://doi.org/10.1007/BF03320660 DOI: https://doi.org/10.1007/BF03320660
Merck & Co. Inc. Program to Assess Ceftolozano/Tazobactam Susceptibility (PACTS) database. 2019.
Raman G, Avendano E, Berger S, Menon V. Appropriate initial antibiotic therapy in hospitalized patients with gram-negative infections: systematic review and meta-analysis. BMC Infect Dis. 2015;15(1):395. https://doi.org/10.1186/s12879-015-1123-5 PMID:26423743 DOI: https://doi.org/10.1186/s12879-015-1123-5
Siempos II, Vardakas KZ, Kyriakopoulos CE, Ntaidou TK, Falagas ME. Predictors of mortality in adult patients with ventilator-associated pneumonia: a meta-analysis. Shock. 2010;33(6):590-601. https://doi.org/10.1097/SHK.0b013e3181cc0418PMID:19953007 DOI: https://doi.org/10.1097/SHK.0b013e3181cc0418
ISTAT. 2017; Online: http://dati.istat.it/Index.aspx?DataSetCode=DCIS_MORTALITA1#. (Accessed June 2021)
Merck & Co. Inc. IMI/REL model specification validation interviews. June - October 2017.
Whittington MD, Atherly AJ, Curtis DJ, Lindrooth RC, Bradley CJ, Campbell JD. Recommendations for Methicillin-Resistant Staphylococcus aureus Prevention in Adult ICUs: A Cost-Effectiveness Analysis. Crit Care Med. 2017;45(8):1304-1310. https://doi.org/10.1097/CCM.0000000000002484 PMID:28471887 DOI: https://doi.org/10.1097/CCM.0000000000002484
Lee BY, Wiringa AE, Bailey RR, et al. The economic effect of screening orthopedic surgery patients preoperatively for methicillin-resistant Staphylococcus aureus. Infect Control Hosp Epidemiol. 2010;31(11):1130-1138. https://doi.org/10.1086/656591 PMID:20923285 DOI: https://doi.org/10.1086/656591
Scalone L, Cortesi P, Ciampichini R et al. Health related quality of life norm data of the general population in Italy: results using the EQ-5D-3L and EQ-5D-5L instruments. Epidemiol Biostat Public Health. 2015; 12(3): e11457. http://dx.doi.org/10.2427/11457
ISTAT. Indice dei prezzi al consumo per famiglie, operai ed impiegati. Online: http://rivaluta.istat.it:8080/Rivaluta/(Accessed June 2021)
Joshi M, Metzler M, McCarthy M, Olvey S, Kassira W, Cooper A. Comparison of piperacillin/tazobactam and imipenem/cilastatin, both in combination with tobramycin, administered every 6 h for treatment of nosocomial pneumonia. Respir Med. 2006;100(9):1554-1565. https://doi.org/10.1016/j.rmed.2006.01.004 PMID:16487695 DOI: https://doi.org/10.1016/j.rmed.2006.01.004
Lucioni et al., Farmeconomia e percorsi terapeutici. 2001. 2(3). DOI: https://doi.org/10.7175/fe.v2i3.727
Ministero dell’Economia e delle Finanze. Libro verde sulla spesa pubblica. Online: https://www.mef.gov.it/ministero/commissioni/ctfp/documenti/Libro_verde_spesa_pubblica.pdf (Accessed June 2021)
Tariffario nazionale. Remunerazione delle prestazioni di assistenza ospedaliera per acuti, assistenza ospedaliera di riabilitazione e di lungodegenza post acuzie e di assistenza specialistica ambulatoriale. 2013 Online: .https://www.gazzettaufficiale.it/do/atto/serie_generale/caricaPdf?cdimg=13A0052800100010110001&dgu=2013-01-28&art.dataPubblicazioneGazzetta=2013-01-28&art.codiceRedazionale=13A00528&art.num=1&art.tiposerie=SG (Accessed June 2021)
Tariffario delle prestazioni di assistenza specialistica ed ambulatoriale. Online : http://www.trovanorme.salute.gov.it/norme/renderPdf.spring?seriegu=SG&datagu=28/01/2013&redaz=13A00528&artp=3&art=1&subart=1&subart1=10&vers=1&prog=001(Accessed June 2021)
ISTAT. Tasso di occupazione 2019. Online: http://dati.istat.it/Index.aspx?DataSetCode=DCCV_TAXOCCU1 (Accessed June 2021)
OECD. Average annual wages. Online: https://stats.oecd.org/Index.aspx?DataSetCode=AV_AN_WAGE. (Accessed June 2021)
Kalil AC, Metersky ML, Klompas M, et al. Management of Adults With Hospital-acquired and Ventilator-associated Pneumonia: 2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clin Infect Dis. 2016;63(5):e61-e111. https://doi.org/10.1093/cid/ciw353 PMID:27418577 DOI: https://doi.org/10.1093/cid/ciw353
Naik J, Puzniak L, Critchlow S, Elsea D, Dillon RJ, Yang J. Cost Effectiveness of Ceftolozane/Tazobactam Compared with Meropenem for the Treatment of Patients with Ventilated Hospital-Acquired Bacterial Pneumonia and Ventilator-Associated Bacterial Pneumonia. Infect Dis Ther. 2021;10(2):939-954. https://doi.org/10.1007/s40121-021-00436-4PMID:33837518 DOI: https://doi.org/10.1007/s40121-021-00436-4
O’Neill J. Wellcome Trust and UK Government. Tackling Drug-Resistant Infections Globally: final report and recommendations. Maggio; 2016.
Downloads
Additional Files
Published
How to Cite
Issue
Section
Categories
License
Copyright (c) 2022 The authors
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Authors contributing to Global & Regional Health Technology Assessment agree to publish their articles under the CC-BY-NC 4.0 license, which allows third parties to re-use the work without permission as long as the work is properly referenced and the use is non-commercial.
Accepted 2022-02-21
Published 2022-04-07
