COST UTILITY OF INTRAVENTRICULAR TIGECYCLINE VERSUS INTRAVENTRICULAR COLISTIMETHATE SODIUM IN EXTENSIVELY DRUG-RESISTANT CENTRAL NERVOUS SYSTEM INFECTIONS: A RETROSPECTIVE MULTI-CENTRE ANALYSIS
Author(s)
Nouran Hesham Abdelwahab, MSc.
Student, Cairo University, Cairo, Egypt.
Student, Cairo University, Cairo, Egypt.
OBJECTIVES: Central nervous system (CNS) infections caused by extensively drug-resistant (XDR) gram-negative bacteria represent a life-threatening challenge and substantial economic burden with limited therapeutic options. Intraventricular colistimethate sodium (IVT-CMS) is guideline-recommended as a last-resort for carbapenem-resistant pathogens; however, intraventricular tigecycline (IVT-TGC) has been used off-label as a salvage alternative. This study aimed to evaluate the cost-utility of off-label IVT-TGC versus IVT-CMS in XDR CNS infections from a hospital perspective in a resource-constrained setting.
METHODS: A retrospective cost-utility analysis was conducted alongside a cohort study across three tertiary pediatric neurosurgical centers in Egypt (n=70; TGC n=23, CMS n=47). Total direct costs per patient (USD) included: drug acquisition costs (TGC: $10.4/vial, CMS: $4.9/vial), ICU stay ($100/day), laboratory monitoring ($41/visit) and adverse event management ($117.5/episode), based on Egyptian hospitals rates converted at 50 EGP/USD. Quality-adjusted life years (QALYs) were estimated by applying published utility weight for acute pediatric CNS infections (0.2) to observed treatment duration, benchmarked against published meta-analytic estimates for pediatric meningitis (0.029; 95%CI: 0.019-0.039). An incremental cost-utility ratio (ICUR) was calculated and results mapped onto the cost-effectiveness (CE) plane.
RESULTS: Mean total cost per patient was; IVT-TGC: $825.6, IVT-CMS: $1371.9, representing a saving of $546.3 per patient. The dominant cost driver was ICU utilization ($647.8 vs $1108.5), reflecting a shorter mean treatment duration (13.4 vs 19.9 days). Estimated QALYs lost during treatment were lower in the IVT-TGC arm (0.0073 vs 0.0109), yielding an incremental QALY gain of 0.0036/patient. The incremental analysis placed IVT-TGC in the south-east quadrant of the CE plane, confirming dominance (ΔCost= $-546.3; ΔQALY= +0.0036).
CONCLUSIONS: Despite its off-label status, IVT-TGC was dominant over IVT-CMS, delivering lower total treatment costs and higher QALYs driven by shorter ICU stay. These findings provide the first cost-utility evidence supporting IVT-TGC use and warrant consideration in antimicrobial stewardship protocols in resource-limited settings.
METHODS: A retrospective cost-utility analysis was conducted alongside a cohort study across three tertiary pediatric neurosurgical centers in Egypt (n=70; TGC n=23, CMS n=47). Total direct costs per patient (USD) included: drug acquisition costs (TGC: $10.4/vial, CMS: $4.9/vial), ICU stay ($100/day), laboratory monitoring ($41/visit) and adverse event management ($117.5/episode), based on Egyptian hospitals rates converted at 50 EGP/USD. Quality-adjusted life years (QALYs) were estimated by applying published utility weight for acute pediatric CNS infections (0.2) to observed treatment duration, benchmarked against published meta-analytic estimates for pediatric meningitis (0.029; 95%CI: 0.019-0.039). An incremental cost-utility ratio (ICUR) was calculated and results mapped onto the cost-effectiveness (CE) plane.
RESULTS: Mean total cost per patient was; IVT-TGC: $825.6, IVT-CMS: $1371.9, representing a saving of $546.3 per patient. The dominant cost driver was ICU utilization ($647.8 vs $1108.5), reflecting a shorter mean treatment duration (13.4 vs 19.9 days). Estimated QALYs lost during treatment were lower in the IVT-TGC arm (0.0073 vs 0.0109), yielding an incremental QALY gain of 0.0036/patient. The incremental analysis placed IVT-TGC in the south-east quadrant of the CE plane, confirming dominance (ΔCost= $-546.3; ΔQALY= +0.0036).
CONCLUSIONS: Despite its off-label status, IVT-TGC was dominant over IVT-CMS, delivering lower total treatment costs and higher QALYs driven by shorter ICU stay. These findings provide the first cost-utility evidence supporting IVT-TGC use and warrant consideration in antimicrobial stewardship protocols in resource-limited settings.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE343
Topic
Clinical Outcomes, Economic Evaluation, Patient-Centered Research
Disease
Infectious Disease (non-vaccine), No Additional Disease & Conditions/Specialized Treatment Areas