2200. Cost-effectiveness of Ceftolozane/Tazobactam for Treating Ventilated Nosocomial Bacterial Pneumonia

Abstract

BackgroundVentilated, hospital-acquired and ventilator-associated bacterial pneumonia (vHABP/VABP) are associated with high rates of antibiotic resistance and high morbidity and mortality in hospitalized patients. Ceftolozane/tazobactam (C/T) has shown non-inferiority to meropenem for treating HABP/VABP in a Phase III trial, ASPECT-NP. This study evaluates cost-effectiveness of C/T against meropenem in treating HABP/VABP.MethodsWe developed a model consisting of a short-term decision tree (reflecting the in-hospital period) followed by a long-term Markov structure (capturing lifetime costs and outcomes). Patient characteristics and clinical efficacy were informed by subjects in ASPECT-NP who received any dose of study drugs. Susceptibility was based on the Program to Assess C/T Susceptibility surveillance database. Second-line and salvage treatment were added to resemble real-world treatment patterns and used to calculate overall clinical cure and mortality rates based on results from a network meta-analysis. We analyzed two clinical scenarios: (1)”confirmed treatment’ in which C/T or meropenem is used after pathogen susceptibility is known; (2) ‘initial treatment’ of high-risk patients before susceptibility is known. Model outcomes include, percentage clinically cured, short-term mortality, direct medical costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios. Sensitivity analyses (SAs) were conducted to test the robustness of results.ResultsIn the confirmed treatment setting, C/T had a higher cure rate (5.0 percentage points, the same below), lower short-term mortality (−5.1%), cost more ($2,728), and yielded higher lifetime QALYs (0.61) than meropenem ($4,472/QALY gained). In the initial treatment setting, C/T sustained a better clinical performance (9.5% more cure, −6.8% mortality, 1.16 more QALYs), yet cost less than meropenem (−$5,662) due to better susceptibility. The response and mortality rates from ASPECT-NP had the greatest impact on results. SAs showed that the result of C/T being cost-effective over meropenem was generally robust.ConclusionThe results indicate that, compared with meropenem, C/T could be a cost-effective option for patients with vHABP/VABP in the US setting.Disclosures All authors: No reported disclosures.