Presentation (CTI)

OBJECTIVES: Complicated urinary tract infections (cUTIs) are ubiquitous and associated with healthcare resource use, and effective antibiotic treatment is essential to prevent clinical failure and relapse. However, evidence is limited on the health economic implications of different treatment options. Recent studies have shown that cefepime/enmetazobactam vs. piperacillin/tazobactam met noninferiority as well as superiority criteria in terms of the combined endpoint of clinical cure and microbiological eradication, the latter being closely linked to reduced relapse rates. Therefore, we perform a health economic evaluation of cefepime/enmetazobactam vs. piperacillin/tazobactam for cUTI treatment from a German payer perspective.
METHODS: To assess the monetary impact of both antibiotic therapies we conducted a stepwise approach, starting with a semi-structured literature review for total cost evaluation of cUTI and relapsed cUTI. Subsequently, we adjusted international costs to the German healthcare system using the OECD’s most recent common European price levels of the year 2017. Converted costs built the basis for the comparative health economic analysis by means of a decision tree using outcome probabilities and relapse rates for both antibiotic treatment options. Lastly, we performed a final verification using publicly available remuneration data from German hospitals.
RESULTS: Literature revealed cost values of €5,394 and €6,675 per patient without and with clinical relapse, respectively, which converted to €5,137.14 and €6,357.14 per patient without and with clinical relapse in Germany. Considering the probability of occurrence of clinical cure, microbiological persistence, and relapse rates, average treatment costs per patient for cefepime/enmetazobactam amount to €5,332.12 compared to €5,414.83 for piperacillin/tazobactam.
CONCLUSIONS: The health economic analysis as one of many aspects to consider in the clinical context shows that a higher probability of relapse after antibiotic therapy might be associated with an increase in treatment costs within the German healthcare system. However, further health economic analyses are needed to improve evidence from other health economic perspectives.