Cost-Effectiveness Analysis of Aztreonam Avibactam (ATMAVI) ± Metronidazole (MTZ) for the Treatment of Complicated Intra-Abdominal Infections (cIAIs) and Ventilator-Associated Hospital-Acquired Pneumonia (HAP/VAP) Caused by Suspected MBL-Producing...
Author(s)
Sheng Tzu Hung, MHA, Ya-Min Yang, MSc, PhD, MD.
Pfizer, Taipei, Taiwan.
Pfizer, Taipei, Taiwan.
OBJECTIVES: Metallo-β-lactamases (MBLs) are a type of carbapenemase produced by bacteria that cause resistance to many antibiotics. Aztreonam-avibactam (ATM-AVI; EMBLAVEO®) is the first EU approved β-lactam/β-lactamase inhibitor combination indicated for serious infections due to Gram-negative bacteria, including MBL-producing multidrug-resistant pathogens. This analysis assesses the cost-effectiveness of ATM-AVI for complicated intra-abdominal infections (cIAI) and hospital- or ventilator-associated pneumonia (HAP/VAP).
METHODS: This study used a 38-day decision tree followed by a Markov model over a 5-year horizon to evaluate the medical costs and clinical outcomes of ATM-AVI ± metronidazole versus meropenem ± colistin (for cIAI) or meropenem-based therapy (for HAP/VAP) from a payer perspective. Treatment effectiveness was based on the REVISIT trial, which included 38% Asian patients—some from Taiwan—supporting local relevance. Sensitivity and scenario analyses addressed input uncertainties. All costs and utilities were discounted at 3% annually.
RESULTS: With all available parameters, in cIAI cases, ATM-AVI ± MTZ is associated with a with incremental costs of NTD 135,172 and incremental QALYs of 0.45 vs MER ± COL, resulting in an ICER of NTD 300,680 per QALY gained. In HAP/VAP, ATM-AVI ± MTZ is associated with incremental costs of NTD 144,759 and incremental QALYs of 0.43 vs meropenem-based therapy, resulting in an ICER of NTD 338,295 per QALY gained. Both of results are lower than 1x GDP per QALY. Several sensitivity analyses including one-way sensitivity analysis, probabilistic sensitivity analysis, and scenario analysis were explored. Key cost-effectiveness drivers include cure probabilities, resistance rates, and the impact of resistance and nephrotoxicity on outcomes such as hospital stay.
CONCLUSIONS: For patients with cIAI and HAP/VAP, and assuming a cost-effectiveness threshold of NTD 1150478 per QALY, treatment with ATM-AVI is considered a highly cost-effective use of healthcare resources in Taiwan.
METHODS: This study used a 38-day decision tree followed by a Markov model over a 5-year horizon to evaluate the medical costs and clinical outcomes of ATM-AVI ± metronidazole versus meropenem ± colistin (for cIAI) or meropenem-based therapy (for HAP/VAP) from a payer perspective. Treatment effectiveness was based on the REVISIT trial, which included 38% Asian patients—some from Taiwan—supporting local relevance. Sensitivity and scenario analyses addressed input uncertainties. All costs and utilities were discounted at 3% annually.
RESULTS: With all available parameters, in cIAI cases, ATM-AVI ± MTZ is associated with a with incremental costs of NTD 135,172 and incremental QALYs of 0.45 vs MER ± COL, resulting in an ICER of NTD 300,680 per QALY gained. In HAP/VAP, ATM-AVI ± MTZ is associated with incremental costs of NTD 144,759 and incremental QALYs of 0.43 vs meropenem-based therapy, resulting in an ICER of NTD 338,295 per QALY gained. Both of results are lower than 1x GDP per QALY. Several sensitivity analyses including one-way sensitivity analysis, probabilistic sensitivity analysis, and scenario analysis were explored. Key cost-effectiveness drivers include cure probabilities, resistance rates, and the impact of resistance and nephrotoxicity on outcomes such as hospital stay.
CONCLUSIONS: For patients with cIAI and HAP/VAP, and assuming a cost-effectiveness threshold of NTD 1150478 per QALY, treatment with ATM-AVI is considered a highly cost-effective use of healthcare resources in Taiwan.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
HTA92
Topic
Economic Evaluation, Health Technology Assessment
Disease
Infectious Disease (non-vaccine)