Cost-effectiveness analysis of ceftazidime/avibactam compared to imipenem as empirical treatment for complicated urinary tract infections
Cost-effectiveness analysis of ceftazidime/avibactam compared to imipenem as empirical treatment for complicated urinary tract infections
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DOI：
10.1016/j.ijantimicag.2019.06.008
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发表时间：
2019-11-01
影响因子：
10.8
通讯作者：
Charbonneau, Claudie
中科院分区：
文献类型：
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作者：
Kongnakorn, Thitima;Wagenlehner, Florian;Charbonneau, Claudie
头孢他啶/阿维巴坦(CAZ-AVI)是一种新型的固定剂量组合抗生素，已在欧洲和美国获得批准，用于复杂尿路感染(CUTIS)患者，这是基于第三阶段随机比较研究(Recapture Study)的结果。目前的分析从意大利公共资助的医疗保健(第三方付款人)的角度评估了CAZ-AVI作为皮肤病住院患者的经验性治疗的成本效益。建立了一个循序渐进的患者水平模拟模型，该模型跟踪了cUTI的临床过程，产生了5万对完全相同的患者(CAZ-AVI或亚胺培南作为经验治疗)。该模型包括耐药病原体的额外影响；在两组中，对经验性治疗没有反应的患者都切换到粘菌素+大剂量碳青霉烯的二线治疗。该模型的时间范围为五年，成本和质量调整生命年(QALY)的年贴现率均为3%。分析表明，与对照序列(亚胺培南、粘菌素+高剂量碳青霉烯)相比，干预序列(CAZ-AVI、粘菌素+高剂量碳青霉烯)与对照序列(亚胺培南、粘菌素+高剂量碳青霉烯)相比，每名患者的净增量成本(SIC)为1015，但在临床治愈方面提供了更好的健康结果(97.65%比91.08%；Delta=6.57%)、更短的住院时间(10.65天比12.55天；Delta=1.90天)，以及每个患者的QALY收益(4.190比4.063；Delta=0.126)。增量成本效益比为(原文)8039/QALY，远低于意大利的(原文如此)30000/QALY的支付意愿阈值。结果显示，在意大利，与亚胺培南相比，CAZ-AVI有望成为治疗慢性尿路感染的一种经济有效的治疗方法。(C)2019年提交人。爱思唯尔出版公司(Elsevier B.V.)
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 50 00 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 (sic)1015 per patient but provided better health outcomes in terms of clinical cure (97.65% vs. 91.08%; Delta = 6.57%), shorter hospital stays (10.65 vs. 12.55 days; Delta = 1.90 days), and QALYs gained per patient (4.190 vs. 4.063; Delta = 0.126). The incremental cost-effectiveness ratio was (sic)8039/QALY, which is well below the willingness-to-pay threshold of (sic)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. (C) 2019 The Authors. Published by Elsevier B.V.