Cost-effectiveness of IMI/CIL/REL for the treatment of carbapenem non-susceptible Gram-negative bacterial infections
DOI:
https://doi.org/10.33393/grhta.2023.2488Keywords:
Cost-effectiveness, Economic evaluation, Gram-negative bacterial infectionAbstract
Objective: The objective of this analysis was to evaluate the cost-effectiveness of imipenem/cilastatin/relebactam compared to colistin-imipenem in the treatment of hospitalized patients with Gram-negative bacterial infections caused by imipenem-resistant pathogens. The perspective was both that of the National Health Service (NHS) and the social one.
Methodology: A mixed model was developed to simulate a cohort of patients capable of highlighting the impacts of the disease on the quality of life and the absorption of economic resources of the patients in analysis. Modelled patients were those with hospital-acquired bacterial pneumonia/ventilator-associated bacterial pneumonia (HABP/VABP), complicated intra-abdominal infection (cIAI) or complicated urinal tract infection (cUTI) caused by carbapenem-resistant Gram-negative (GN) pathogens. The model begins with a short-term decision tree describing possible treatment routes and outcomes for patients during the hospitalization period. Patients who are healed in the decision tree enter the long-term Markov model, designed to capture the follow-up costs and health-related quality of life (HRQL) of patients healed over their lifetime.
Results: The analysis, conducted on a hypothetical cohort of 1,000 patients, highlights how the use of imipenem/cilastatin/relebactam is advantageous both in terms of diagnosis and treatment in the short term and in terms of cost-effectiveness. In fact, it is dominant compared to colistin-imipenem both in the NHS and in the social perspective since, compared to an average saving of € 2,800.15 and € 3,174.63 respectively, it would generate an increase of 4.76 years of life and of 4.12 QALYs per patient.
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References
Cassini A, Högberg LD, Plachouras D, et al; Burden of AMR Collaborative Group. Attributable deaths and disability-adjusted life-years caused by infections with antibiotic-resistant bacteria in the EU and the European Economic Area in 2015: a population-level modelling analysis. Lancet Infect Dis. 2019;19(1):56-66. https://doi.org/10.1016/S1473-3099(18)30605-4 PMID:30409683 DOI: https://doi.org/10.1016/S1473-3099(18)30605-4
Fondazione House of Ambrosetti. Rapporto Meridiano Sanità 2017. Online: https://acadmin.ambrosetti.eu/dompdf/crea_wmark.php?doc=L2F0dGFjaG1lbnRzL3BkZi9yYXBwb3J0by1tczIwMTctMjAyMTA0MDIxMC5wZGY%3D&id=11962&muid=corporate (Accessed August 2022).
Antibacterial agents in clinical development - An analysis of the antibacterial clinical development pipeline. Online https://apps.who.int/iris/bitstream/handle/10665/330420/9789240000193-eng.pdf (Accessed August 2022)
Istituto Superiore di Sanità. Antibiotico-resistenza. Aspetti epidemiologici in Italia. Online https://www.epicentro.iss.it/antibiotico-resistenza/epidemiologia-italia (Accessed August 2022)
Circolare Min. Sal. del 3/12/2019. Rapid Risk Assessment dell’ECDC: enterobatteri resistenti ai carbapenemi (CRE) 26 settembre 2019. Ten threats to global health in 2019. Online https://www.trovanorme.salute.gov.it/norme/renderNormsanPdf?anno=2019&codLeg=71976&parte=1%20&serie=null (Accessed August 2022)
Girometti N, Lewis RE, Giannella M, et al. Klebsiella pneumoniae bloodstream infection: epidemiology and impact of inappropriate empirical therapy. Medicine (Baltimore). 2014;93(17):298-309. https://doi.org/10.1097/MD.0000000000000111 PMID:25398065 DOI: https://doi.org/10.1097/MD.0000000000000111
De Angelis G, D’Inzeo T, Fiori B et al. Burden of Antibiotic Resistant Gram Negative Bacterial Infections: evidence and Limits. J Med Microbiol Diagn. 2014;3:1. Online https://www.hilarispublisher.com/open-access/burden-of-antibiotic-resistant-gram-negative-bacterial-infections-evidence-and-limits-2161-0703.1000132.pdf (Accessed August 2022)
Motsch J, Murta de Oliveira C, Stus V, et al. RESTORE-IMI 1: A Multicenter, Randomized, Double-blind Trial Comparing Efficacy and Safety of Imipenem/Relebactam vs Colistin Plus Imipenem in Patients With Imipenem-nonsusceptible Bacterial Infections. Clin Infect Dis. 2020;70(9):1799-1808. https://doi.org/10.1093/cid/ciz530 PMID:31400759 DOI: https://doi.org/10.1093/cid/ciz530
CHEERS 2022 Checklist. Online https://www.equator-network.org/wp-content/uploads/2013/04/CHEERS-2022-checklist-1.pdf (Accessed August 2022)
Fattore G; AIES. 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
Mennini FS, Paoletti M, Bini C, Marcellusi A, Falcone M, Andreoni M. Cost-utility analysis of ceftolozane/tazobactam vs meropenem in patients with hospital-acquired pneumonia (HABP) or ventilator-associated pneumonia (VABP). Glob Reg Health Technol Assess. 2022;9(1):45-57. https://doi.org/10.33393/grhta.2022.2287 PMID:36628307 DOI: https://doi.org/10.33393/grhta.2022.2287
Suetens C, Latour K, Kärki T, et al; Healthcare-Associated Infections Prevalence Study Group. Prevalence of healthcare-associated infections, estimated incidence and composite antimicrobial resistance index in acute care hospitals and long-term care facilities: results from two European point prevalence surveys, 2016 to 2017. Euro Surveill. 2018;23(46):1800516. https://doi.org/10.2807/1560-7917.ES.2018.23.46.1800516 PMID:30458912 DOI: https://doi.org/10.2807/1560-7917.ES.2018.23.46.1800516
Sievert DM, Ricks P, Edwards JR, et al; National Healthcare Safety Network (NHSN) Team and Participating NHSN Facilities. Antimicrobial-resistant pathogens associated with healthcare-associated infections: summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2009-2010. Infect Control Hosp Epidemiol. 2013;34(1):1-14. https://doi.org/10.1086/668770 PMID:23221186 DOI: https://doi.org/10.1086/668770
Zarb P, Coignard B, Griskeviciene J, et al; National Contact Points for the ECDC pilot point prevalence survey; Hospital Contact Points for the ECDC pilot point prevalence survey. The European Centre for Disease Prevention and Control (ECDC) pilot point prevalence survey of healthcare-associated infections and antimicrobial use. Euro Surveill. 2012;17(46):20316. https://doi.org/10.2807/ese.17.46.20316-en PMID:23171822 DOI: https://doi.org/10.2807/ese.17.46.20316-en
European Centre for Disease Prevention and Control. Point prevalence survey of healthcare associated infections and antimicrobial use in European acute care hospitals. 2013; Online https://www.ecdc.europa.eu/sites/default/files/media/en/publications/Publications/healthcare-associated-infections-antimicrobial-use-PPS.pdf (Accessed August 2022)
ECDC. Antimicrobial resistance surveillance in Europe 2012. List of microorganism - pneumoniae. Online https://www.ecdc.europa.eu/sites/default/files/media/en/publications/Publications/antimicrobial-resistance-surveillance-europe-2012.pdf (Accessed August 2022)
Malacarne P, Langer M, Nascimben E, et al; Italian Group for the Evaluation of Interventions in Intensive Care Medicine. Building a continuous multicenter infection surveillance system in the intensive care unit: findings from the initial data set of 9,493 patients from 71 Italian intensive care units. Crit Care Med. 2008;36(4):1105-1113. https://doi.org/10.1097/CCM.0b013e318169ed30 PMID:18379234 DOI: https://doi.org/10.1097/CCM.0b013e318169ed30
Sartelli M, Catena F, Ansaloni L, et al. Complicated intra-abdominal infections in Europe: a comprehensive review of the CIAO study. World J Emerg Surg. 2012;7(1):36. https://doi.org/10.1186/1749-7922-7-36 PMID:23190741 DOI: https://doi.org/10.1186/1749-7922-7-36
Archivio Farmadati. Online https://gallery.farmadati.it
Lucioni, C., et al., I costi della sepsi in Italia. Farmeconomia e percorsi terapeutici, 2001. 2(3). https://doi.org/10.7175/fe.v2i3.727 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 August 2022)
Tariffario nazionale. Remunerazione delle prestazioni di assistenza specialistica ambulatoriale. 2013. Online https://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 August 2022)
Simon MS, Sfeir MM, Calfee DP, Satlin MJ. Cost-effectiveness of ceftazidime-avibactam for treatment of carbapenem-resistant Enterobacteriaceae bacteremia and pneumonia. Antimicrob Agents Chemother. 2019;63(12):e00897-e19. https://doi.org/10.1128/AAC.00897-19PMID:31548187 DOI: https://doi.org/10.1128/AAC.00897-19
Tariffario nazionale. Remunerazione delle prestazioni di assistenza ospedaliera. 2013. Online https://www.trovanorme.salute.gov.it/norme/renderPdf.spring?seriegu=SG&datagu=28/01/2013&redaz=13A00528&artp=1&art=1&subart=1&subart1=10&vers=1&prog=001 (Accessed August 2022)
Alexander EL, Loutit J, Tumbarello M, et al. Carbapenem-Resistant EnterobacteriaceaeInfections: Results From a Retrospective Series and Implications for the Design of Prospective Clinical Trials. Open Forum Infect Dis. 2017;4(2):ofx063. https://doi.org/10.1093/ofid/ofx063PMID:28584849 DOI: https://doi.org/10.1093/ofid/ofx063
ISTAT. Tasso di occupazione. 2018. Online http://dati.istat.it/Index.aspx?DataSetCode=DCCV_TAXOCCU1 (Accessed August 2022)
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
Ara R, Brazier JE. Using health state utility values from the general population to approximate baselines in decision analytic models when condition-specific data are not available. Value Health. 2011;14(4):539-545. https://doi.org/10.1016/j.jval.2010.10.029 PMID:21669378 DOI: https://doi.org/10.1016/j.jval.2010.10.029
ISTAT. Tavole di mortalità. Online http://dati.istat.it/Index.aspx?DataSetCode=DCIS_MORTALITA1# (Accessed August 2022)
Righi E, Peri AM, Harris PN, et al. Global prevalence of carbapenem resistance in neutropenic patients and association with mortality and carbapenem use: systematic review and meta-analysis. J Antimicrob Chemother. 2017 Mar 1;72(3):668-677. https://doi.org/10.1093/jac/dkw459 PMID:27999023 DOI: https://doi.org/10.1093/jac/dkw459
ISTAT. Indice dei prezzi al consumo per famiglie, operai ed impiegati. Online https://www.istat.it/it/archivio/30440
Gold MR, Franks P, McCoy KI, Fryback DG. Toward consistency in cost-utility analyses: using national measures to create condition-specific values. Med Care. 1998;36(6):778-792. https://doi.org/10.1097/00005650-199806000-00002 PMID:9630120 DOI: https://doi.org/10.1097/00005650-199806000-00002
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
Jim O’Neill. Wellcome Trust and UK Government. Tackling Drug-Resistant Infections Globally: final report and recommendations. The Review on Antimicrobial Resistance. May 2016; Online https://amr-review.org/sites/default/files/160518_Final%20paper_with%20cover.pdf (Accessed August 2022)
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Accepted 2023-02-26
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