OBJECTIVES

Carbapenem-resistant (CR) gram negative pathogens present a particular threat and WHO highlighted three priority pathogens (CR Enterobacterales, CR Pseudomonas aeruginosa, CR Acinetobacter baumannii) which cefiderocol, a new parental antibiotic can target. Here, we determine the cost-effectiveness of cefiderocol compared to colistin and colistin based regimens for treatment of complicated Urinary Tract Infections (cUTI), Pneumonia and Bloodstream infection/sepsis in patients who have confirmed CR pathogen.

METHODS

A decision tree was adopted for the treatment pathway with two separate subgroups of patients; either at high risk of a carbapenem-resistant infection or a confirmed CR infection (determined by microbiological testing). Only confirmed CR population are considered here. Published literature was used for cost inputs and Italian microbiological susceptibility data were used to determine susceptibility to CR pathogen. Treatment effectiveness data for cefiderocol and colistin was inputted from the CREDIBLE – CR trial. No inappropriate therapies could be selected since the pathogen susceptibility was known at the time of intervention and no de-escalation was required. The evaluation was performed from both a healthcare and a societal perspective over a lifetime time horizon, using the ICER annual discount rate of 3%. A probabilistic sensitivity analysis (PSA) was also conducted to account for uncertainty. The cost-effectiveness threshold was set at €40,000.

RESULTS

A summary of the base case cost-effectiveness results for the confirmed carbapenem-resistant population are as follows for cefiderocol and colistin respectively: cost per patient is €15,988 vs €12,732; QALYS are 10.20 vs 9.70 and discounted LY per patient are 13.46 vs 12.81. The ICER,€6,515, is below the cost-effectiveness threshold. A PSA was conducted to show a probability of cost-effectiveness of 71.4% (ICER: €5,972).

CONCLUSIONS

Cefiderocol is estimated to be cost-effective for the treatment of confirmed CR infections in Italy, when compared to colistin and colistin based regimens, but further research is warranted for comparisons to other antibiotics.