Estimating the Clinical and Economic Value of Aztreonam-Avibactam for the Treatment of Metallo-Beta-Lactamase–Producing Carbapenem- Resistant Enterobacterales Infections in China: Adopting the STEDI Value Framework
Author(s)
Dunming Xiao, MS1, Qiang Liu, PhD2, Peng Dong, PhD2, James W. Dennis3, Silviya Nikolova, PhD4, Edward Ivor Broughton, BSc, MPH, PhD5, Maria Gheorghe, PhD6, Shweta Kamat, PhD7, Yi Yang, MS, PhD1, YINGYAO CHEN, PhD1.
1Fudan University, Shanghai, China, 2Pfizer Investment Co Ltd., Beijing, China, 3Cardiff, United Kingdom, 4Health Economics and Outcomes Research Ltd., Cardiff, United Kingdom, 5Pfizer, New York, NY, USA, 6Pfizer, Bucharest, Romania, 7Pfizer Products India Pyt, Mumbai, India.
1Fudan University, Shanghai, China, 2Pfizer Investment Co Ltd., Beijing, China, 3Cardiff, United Kingdom, 4Health Economics and Outcomes Research Ltd., Cardiff, United Kingdom, 5Pfizer, New York, NY, USA, 6Pfizer, Bucharest, Romania, 7Pfizer Products India Pyt, Mumbai, India.
OBJECTIVES: This study aims to estimate the value of aztreonam-avibactam (ATM-AVI) for treating metallo-beta-lactamase-producing carbapenem-resistant Enterobacterales (MBL-CRE) for complicated intra-abdominal infections (cIAI) and hospital-acquired and ventilator-associated pneumonia (HAP/VAP), from the Chinese National Healthcare System perspective, considering the transmission, enablement and diversity (TED) value of antimicrobials described in the STEDI framework (spectrum, transmission, enablement, diversity, and insurance).
METHODS: The TED model combined a dynamic transmission model and decision analysis model to estimate the direct impact of introducing ATM-AVI on treating infections and the indirect effects on transmission of infections and resistance, and how this affects prophylactic outcomes of other antibiotics. ATM-AVI was assessed as a first-line treatment, within the existing two-line treatment strategy (colistin + meropenem and colistin + aminoglycoside). Efficacy, resistance, adverse events, and cost inputs were sourced from the phase 3 REVISIT trial, literature and local expert opinion. A ten-year transmission horizon was used; quality-adjusted life years (QALYs) were estimated over a lifetime. Costs and benefits were discounted at 5%. A willingness-to-pay threshold of three times China’s per capital GDP in 2024 (CN¥287,247 [$39,981]) was used to calculate net monetary benefit (NMB).
RESULTS: Over ten years, considering TED value elements at the national level, the introduction of ATM-AVI is projected to prevent 401,484 infections and 91,575 deaths, gaining 1,010,284 QALYs. It offers the Chinese healthcare system net savings of CN¥12.6 billion, yielding a NMB of CN¥302 billion. Considering patient-level outcomes, the introduction of ATM-AVI is estimated to lead to 2.22 QALYs gained with savings of CN¥26,483.
CONCLUSIONS: The introduction of ATM-AVI as an additional treatment option for MBL-CRE HAP/VAP and cIAI, in China, offers significant benefits to the healthcare system, providing cost savings and improved population health. Methods to quantify the full value of antimicrobials within the context of AMR should be considered within health technology assessments to address the AMR threat.
METHODS: The TED model combined a dynamic transmission model and decision analysis model to estimate the direct impact of introducing ATM-AVI on treating infections and the indirect effects on transmission of infections and resistance, and how this affects prophylactic outcomes of other antibiotics. ATM-AVI was assessed as a first-line treatment, within the existing two-line treatment strategy (colistin + meropenem and colistin + aminoglycoside). Efficacy, resistance, adverse events, and cost inputs were sourced from the phase 3 REVISIT trial, literature and local expert opinion. A ten-year transmission horizon was used; quality-adjusted life years (QALYs) were estimated over a lifetime. Costs and benefits were discounted at 5%. A willingness-to-pay threshold of three times China’s per capital GDP in 2024 (CN¥287,247 [$39,981]) was used to calculate net monetary benefit (NMB).
RESULTS: Over ten years, considering TED value elements at the national level, the introduction of ATM-AVI is projected to prevent 401,484 infections and 91,575 deaths, gaining 1,010,284 QALYs. It offers the Chinese healthcare system net savings of CN¥12.6 billion, yielding a NMB of CN¥302 billion. Considering patient-level outcomes, the introduction of ATM-AVI is estimated to lead to 2.22 QALYs gained with savings of CN¥26,483.
CONCLUSIONS: The introduction of ATM-AVI as an additional treatment option for MBL-CRE HAP/VAP and cIAI, in China, offers significant benefits to the healthcare system, providing cost savings and improved population health. Methods to quantify the full value of antimicrobials within the context of AMR should be considered within health technology assessments to address the AMR threat.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE424
Topic
Economic Evaluation, Health Policy & Regulatory, Health Technology Assessment
Disease
Infectious Disease (non-vaccine), No Additional Disease & Conditions/Specialized Treatment Areas