Economic Evaluation Of Cefiderocol for the Treatment of Carbapenem-Resistant Acinetobacter Baumannii in Italy Using Real-World Evidence
Author(s)
Maria Laura Notarianni, MSc1, Davide Andretta, MSc2.
1Shionogi, Rome, Italy, 2Shionogi, London, Italy.
1Shionogi, Rome, Italy, 2Shionogi, London, Italy.
OBJECTIVES: Cefiderocol is an antibiotic launched in Italy in 2021. The objective of this economic evaluation was to assess the cost-effectiveness of cefiderocol compared to colistin from the Italian Healthcare perspective in patients with severe infections caused by carbapenem-resistant Acinetobacter baumannii (CRAB).
METHODS: A decision-tree economic model was developed. Microbiological test results are assumed to be available at treatment initiation; therefore, pathogen strain and its antimicrobial susceptibility profile are known at the time patients enter the model. The outcome measure used to inform the movement of patients in the decision-tree model is the probability of 28-day all-cause mortality for cefiderocol and colistin-based regimens obtained from a recently published meta-analysis investigating the relative risk of mortality associated with cefiderocol and colistin in carbapenem-resistant Acinetobacter baumannii infections (OR 0.53; 95%CI 0.41-0.68; p<0.001). The meta-analysis was performed by pooling the adjusted odds ratios extracted from the studies previously identified by a systematic literature review (1 RCT and 6 observational studies) providing adjustment for confounders. A weighted average of three infection sites populations (cUTI, pneumonia and BSI/sepsis) was included in the model. The evaluation was performed using a 5-year time horizon with 3% discount rate for costs and benefits (as AIFA and ISPOR Guidelines recommend). The threshold for cost-effectiveness considered was €40,000 per additional QALY. Deterministic and probabilistic sensitivity analyses were conducted to assess the impact of bias on the model results.
RESULTS: In a carbapenem-resistant Acinetobacter baumannii population, the base-case analysis resulted in an ICER of €8,871/QALY when cefiderocol is compared against colistin and colistin-based regimens. PSA showed that cefiderocol was cost-effective in 100% of all simulations.
CONCLUSIONS: The analysis that included new evidence on cefiderocol effectiveness confirmed the economic value of cefiderocol versus colistin-based regimens for the treatment of critically ill patients with severe infections caused by carbapenem-resistant Acinetobacter baumannii.
METHODS: A decision-tree economic model was developed. Microbiological test results are assumed to be available at treatment initiation; therefore, pathogen strain and its antimicrobial susceptibility profile are known at the time patients enter the model. The outcome measure used to inform the movement of patients in the decision-tree model is the probability of 28-day all-cause mortality for cefiderocol and colistin-based regimens obtained from a recently published meta-analysis investigating the relative risk of mortality associated with cefiderocol and colistin in carbapenem-resistant Acinetobacter baumannii infections (OR 0.53; 95%CI 0.41-0.68; p<0.001). The meta-analysis was performed by pooling the adjusted odds ratios extracted from the studies previously identified by a systematic literature review (1 RCT and 6 observational studies) providing adjustment for confounders. A weighted average of three infection sites populations (cUTI, pneumonia and BSI/sepsis) was included in the model. The evaluation was performed using a 5-year time horizon with 3% discount rate for costs and benefits (as AIFA and ISPOR Guidelines recommend). The threshold for cost-effectiveness considered was €40,000 per additional QALY. Deterministic and probabilistic sensitivity analyses were conducted to assess the impact of bias on the model results.
RESULTS: In a carbapenem-resistant Acinetobacter baumannii population, the base-case analysis resulted in an ICER of €8,871/QALY when cefiderocol is compared against colistin and colistin-based regimens. PSA showed that cefiderocol was cost-effective in 100% of all simulations.
CONCLUSIONS: The analysis that included new evidence on cefiderocol effectiveness confirmed the economic value of cefiderocol versus colistin-based regimens for the treatment of critically ill patients with severe infections caused by carbapenem-resistant Acinetobacter baumannii.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE376
Topic
Economic Evaluation
Disease
Infectious Disease (non-vaccine)