HEALTH ECONOMIC IMPACT OF DELAYED MODEL-INFORMED PRECISION DOSING FOR HIGH-RISK ANTIBIOTICS IN CRITICALLY ILL PATIENTS: A PHARMACOMETRIC-PHARMACOECONOMIC SIMULATION
Author(s)
Jesmitha J. M, PharmD1, Ganesan Rajalekshmi Saraswathy, PhD2.
1Student, M S Ramaiah University Of Applied Sciences, Bengaluru, India, 2M S Ramaiah University Of Applied Sciences, Bangalore, India.
1Student, M S Ramaiah University Of Applied Sciences, Bengaluru, India, 2M S Ramaiah University Of Applied Sciences, Bangalore, India.
OBJECTIVES: This study evaluated the clinical and economic impact of delayed Bayesian MIPD across two high-risk antibiotics requiring therapeutic drug monitoring—vancomycin and polymyxin B—in critically ill adults.
METHODS: Monte Carlo simulations of 5,000 virtual critically ill adults were performed separately using published population pharmacokinetic models for vancomycin and polymyxin B. Standard empirical dosing was compared with Bayesian MIPD initiated on treatment days 1, 2, 3, or 4. Drug-specific therapeutic exposure targets were applied (vancomycin AUC24/MIC 400-600 mg·h/L; polymyxin B AUCss,24h 50-100 mg·h/L). Decision-analytic models estimated direct medical costs, quality-adjusted life years (QALYs), incremental cost-effectiveness, and net monetary benefit (NMB) from the perspective of an Indian private intensive care unit. Probabilistic sensitivity analyses evaluated parameter uncertainty.
RESULTS: For vancomycin, early MIPD increased therapeutic target attainment from 21.4% to 92.8%, reduced AKI from 47.2% to 13.3%, decreased mean treatment costs from ₹180,368 to ₹146,160, and increased QALYs from 3.277 to 3.401, generating an incremental NMB of ₹59,037 compared with standard dosing. Delaying MIPD progressively reduced economic value, with NMB losses of ₹7,392, ₹18,945, and ₹29,135 when implementation was postponed to treatment days 2, 3, and 4, respectively. For polymyxin B, early MIPD increased therapeutic target attainment from 46.5% to 94.6%, improved simulated treatment response from 54.6% to 76.8%, reduced AKI from 23.5% to 15.2%, and reduced resistance emergence from 18.5% to 4.0%. Mean costs decreased from ₹178,806 to ₹163,272, while QALYs increased from 3.281 to 3.378, producing an incremental NMB of ₹34,914 versus standard dosing. Delayed implementation resulted in progressive reductions in economic value, with NMB losses of ₹4,394, ₹10,769, and ₹18,013 for treatment days 2, 3, and 4, respectively.
CONCLUSIONS: Across two mechanistically distinct antibiotics, early Bayesian model-informed precision dosing consistently improved therapeutic target attainment, reduced nephrotoxicity, lowered healthcare costs, and increased quality-adjusted survival compared with conventional dosing.
METHODS: Monte Carlo simulations of 5,000 virtual critically ill adults were performed separately using published population pharmacokinetic models for vancomycin and polymyxin B. Standard empirical dosing was compared with Bayesian MIPD initiated on treatment days 1, 2, 3, or 4. Drug-specific therapeutic exposure targets were applied (vancomycin AUC24/MIC 400-600 mg·h/L; polymyxin B AUCss,24h 50-100 mg·h/L). Decision-analytic models estimated direct medical costs, quality-adjusted life years (QALYs), incremental cost-effectiveness, and net monetary benefit (NMB) from the perspective of an Indian private intensive care unit. Probabilistic sensitivity analyses evaluated parameter uncertainty.
RESULTS: For vancomycin, early MIPD increased therapeutic target attainment from 21.4% to 92.8%, reduced AKI from 47.2% to 13.3%, decreased mean treatment costs from ₹180,368 to ₹146,160, and increased QALYs from 3.277 to 3.401, generating an incremental NMB of ₹59,037 compared with standard dosing. Delaying MIPD progressively reduced economic value, with NMB losses of ₹7,392, ₹18,945, and ₹29,135 when implementation was postponed to treatment days 2, 3, and 4, respectively. For polymyxin B, early MIPD increased therapeutic target attainment from 46.5% to 94.6%, improved simulated treatment response from 54.6% to 76.8%, reduced AKI from 23.5% to 15.2%, and reduced resistance emergence from 18.5% to 4.0%. Mean costs decreased from ₹178,806 to ₹163,272, while QALYs increased from 3.281 to 3.378, producing an incremental NMB of ₹34,914 versus standard dosing. Delayed implementation resulted in progressive reductions in economic value, with NMB losses of ₹4,394, ₹10,769, and ₹18,013 for treatment days 2, 3, and 4, respectively.
CONCLUSIONS: Across two mechanistically distinct antibiotics, early Bayesian model-informed precision dosing consistently improved therapeutic target attainment, reduced nephrotoxicity, lowered healthcare costs, and increased quality-adjusted survival compared with conventional dosing.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
MSR266
Topic
Economic Evaluation, Methodological & Statistical Research, Study Approaches
Disease
Infectious Disease (non-vaccine), Personalized & Precision Medicine