OBJECTIVES : To estimate the cost-effectiveness of ceftolozane/tazobactam compared with cefepime, ciprofloxacin, doripenem, levofloxacin, meropenem, piperacillin/tazobactam, ceftazidime or imipenem/cilastatin for the empiric treatment of complicated urinary tract infections (cUTI) in Colombia.

METHODS : A decision analytic Monte Carlo simulation model was used to estimate the drug and hospitalization-related costs and quality-adjusted life years (QALYs) of patients with cITU empirically treated with ceftolozane/tazobactam or one of the following alternatives: cefepime, ciprofloxacin, doripenem, levofloxacin, meropenem, piperacillin/tazobactam, ceftazidime or imipenem/cilastatin. Bacterial susceptibility to the initial empiric antibiotic therapy was chosen as the efficacy measurement and was obtained from the Latin American Program to Assess Ceftolozane/Tazobactam Susceptibility (PACTS) database. Local costs for Colombia were obtained using base cases with clinical experts and consulting local official databases from drug and procedure prices. Cost-effectiveness threshold was assumed to be three times the per-capita gross domestic product of Colombia (USD 17,948.00 in 2017).

RESULTS : Ceftolozane/Tazobactam was found to be a cost-effective alternative compared with the majority of alternatives in the empirical treatment of cUTI. Its Incremental Cost-Effectiveness Ratio (ICER) when compared with cefepime was US $982.35/QALY, US $1,521.13 /QALY compared with ceftazidime, US $742.87/QALY compared with ciprofloxacin, US $5,215.82/QALY compared with doripenem, US $5,293.15/QALY compared with imipenem/cilastatin, US $1,245.47/QALY compared with levofloxacin and US $1,484.13/QALY compared with piperacillin/tazobactam. Ceftolozane/Tazobactam was dominated by meropenem (US $-9,681.83/QALY), however the difference in QALYs was small (-0.055 QALYs per patient). Sensitivity analysis only considering patients with P. aeruginosa showed that Ceftolozane/Tazobactam had a favorable result (cost-effective or dominant) versus all considered comparators.

CONCLUSIONS : Results suggest that Ceftolozane/Tazobactam may be a cost-effective alternative in the treatment of cUTI. Sensitivity analysis shows more favorable results in patients with P. aeruginosa.