Cost Effectiveness of Novel Antibiotic Ceftolozane/Tazobactam in Patients With Hospital-Acquired Bacterial Pneumonia or Ventilator-Associated Bacterial Pneumonia in Greece

OBJECTIVES: Antimicrobial resistance is a critical public health issue in Greece, which has worsened during COVID-19 pandemic due to antibiotic overuse. The present study assesses the cost-effectiveness of ceftolozane/tazobactam(C/T) in ICU-admitted ventilated hospital-acquired bacterial pneumonia (vHABP) and ventilator-associated bacterial pneumonia (VABP) due to Multiple Drug Resistant Pseudomonas Aeruginosa in Greece.

METHODS:

The model is based on data from ASPECT-NP Phase-3 study and PACTS surveillance data from Italy. The model consists of two parts: a decision-tree, depicting the period from vHABP/VABP diagnosis to hospital discharge and a Markov model, projecting long-term outcomes following hospital discharge. The model calculates costs and outcomes within a 40 years’ time-horizon. Costs and QALYs are discounted at an annual rate of 3.0%. Outcomes included Incremental Cost Effectiveness Ratio(ICER), Quality Adjusted Life Years (QALY’s) and Life Years (LY’s) for each comparator as well as hospital resource use and mortality (for each comparator).The comparator used in the base case analysis was Meropenem. A deterministic sensitivity analysis (DSA) was performed to test the parameters with the greatest impact on the ICER and a Probabilistic Sensitivity Analysis (PSA) was run to test the robustness of the results.

RESULTS:

Patients who received C/T spent 1.97 days less (17.99 days) with mechanical ventilator support compared to Meropenem 19.97 days with mechanical ventilator support. Patients in the treatment arm with Meropenem are expected to have 8.66 LY’s and 7.11 QALY’s with a cost of 33,896€. Whereas patients in the C/T arm are expected to have 10.18 LY’s and 8.34 QALY’s at a cost of 35,135€. The ICER for C/T was 994€ per QALY compared to Meropenem. C/T showed a 99.94% probability of being cost effective at a threshold of 52,770 per QALY € (3x Greek- GDP per capita).

CONCLUSIONS: The present study suggests that Ceftolozane/Tazobactam is a cost-effective treatment for Greek vHABP/VABP patients.