Cost-Utility Analysis Focused on Nosocomial Pneumonia Antimicrobial Therapy -Â Ceftolozane/Tazobactam Role in New Technologies Incorporation within Private Hospitals and HMOs in Brazil
Author(s)
Cavalcanti HE1, Polis TJB1, Almeida M2, de Mendonça Batista P1, Chabrol Haas L1, Rodrigues S1
1MSD Brazil, São Paulo, SP, Brazil, 2MSD Brazil, São Paulo, Brazil
OBJECTIVES : Gram-negative bacterial (GNB) infections have become increasingly difficult to treat due to raising antimicrobial resistance rates in Latin America. The development of new antimicrobial agents is urgent to address resistance mechanisms that current molecules do not tackle. Ceftolozane-tazobactam (C/T) is a beta-lactam-beta-lactamase inhibitor agent that can be considered a clinical option for nosocomial pneumonia in critically ill patients at a high risk of meropenem and piperacillin-tazobactam resistant isolates. METHODS : We applied a model based on a short-term decision tree and 10-year Markov model. This model represents a hospital microbiota where hospitalized patients could be at risk of nosocomial pneumonia (NP) caused by Enterobacterales or Pseudomonas aeruginosa and should receive empiric antimicrobial therapy. The pathogens distribution was adapted from a 2018-2019 Brazil subsample in a global pathogen surveillance database. Clinical outcomes were extracted from a phase 3 trial of NP patients comparing C/T against meropenem. The most common antimicrobials used in NP (piperacillin-tazobactam and meropenem) were selected as comparators. Costs considered were obtained through publications and publicly available databases considering the Brazilian private healthcare perspective. A 5% discount rate was applied to costs and outcomes. RESULTS : When compared to meropenem, the use of C/T can reduce mortality from 32.7% to 29.0%. The use of C/T resulted in 0.22 incremental QALYs with R$10,967.62 incremental costs resulting in an ICER of R$50,701.38/QALY. Considering piperacillin-tazobactam as comparator mortality could decrease from 36.3% to 29.0%, generating 0.93 additional QALYs with R$948.33 additional costs, resulting in an ICER of R$1,019.66/QALY. Antimicrobials accounts for 14.8% of total costs when considering treatment, hospital resource use, adverse events and patient monitoring. Against both comparators the C/T arm patients presented shorter ventilator and ICU length of Stay. CONCLUSIONS : C/T could be a cost-effective option for NP in the Brazilian private healthcare system according to the World Health Organization's threshold.
Conference/Value in Health Info
2021-05, ISPOR 2021, Montreal, Canada
Value in Health, Volume 24, Issue 5, S1 (May 2021)
Code
PIN10
Topic
Economic Evaluation
Topic Subcategory
Cost-comparison, Effectiveness, Utility, Benefit Analysis
Disease
Drugs, Infectious Disease (non-vaccine), Respiratory-Related Disorders