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Abstract
ObjectiveThe study objective of this analysis was to determine the cost-effectiveness of vaborem (meropenem-vaborbactam) compared to the best available therapy (BAT) in adult patients with carbapenem-resistant Enterobacteriaceae—Klebsiella pneumoniae carbapenemase (CRE-KPC) infections from the perspective of the UK National Health Service (NHS) and Personal Social Services (PSS).MethodsA decision tree model was developed to conduct a cost-effectiveness analysis for Vaborem compared to BAT in CRE-KPC patients over a 5 year time horizon. The model structure for Vaborem simulated the clinical pathway of patients with a confirmed CRE-KPC infection. Model inputs for clinical effectiveness were sourced from the TANGO II trial, and published literature. Costs, resource use and utility values associated with CRE-KPC infections in the UK were sourced from the British National Formulary, NHS reference costs and published sources.ResultsOver a 5 year time horizon, Vaborem use increased total costs by £5165 and increased quality-adjusted life years (QALYs) by 0.366, resulting in an incremental cost-effectiveness ratio (ICER) of £14,113 per QALY gained. The ICER was most sensitive to the probability of discharge to long-term care (LTC), the annual cost of LTC and the utility of discharge to home. At thresholds of £20,000/QALY and £30,000/QALY, the probability of Vaborem being cost-effective compared to BAT was 79.85% and 94.93%, respectively.ConclusionDue to a limited cost impact and increase in patient quality of life, vaborem can be considered as a cost-effective treatment option compared to BAT for adult patients with CRE-KPC infections in the UK.
Highlights
Carbapenem-resistant Enterobacteriaceae (CRE) are among the most critical group of multidrug-resistant bacteria worldwide
The incremental cost-effectiveness ratio (ICER) for Vaborem compared to best available therapy (BAT) was £14,113 per quality-adjusted life years (QALYs) gained
The incremental LY for Vaborem compared to BAT was 0.453 (2.183 for Vaborem vs 1.730 for BAT), which was driven primarily by the higher clinical cure rate that patients on Vaborem experienced at day 28, resulting in lower mortality compared to patients on BAT
Summary
Carbapenem-resistant Enterobacteriaceae (recently classified as Enterobacterales) (CRE) are among the most critical group of multidrug-resistant bacteria worldwide. In an effort to aid the prioritisation of research and development of new antibiotics, the World Health Organization (WHO) has listed CRE as a critical priority pathogen due to its increasing incidence and high mortality and morbidity worldwide [1]. Antibiotic-resistant bacteria pose a global threat to human health and each year they are responsible for about 33,000 deaths estimated to cost approximately 1.1 billion Euros to the healthcare systems of the European Economic. CRE incidence has increased significantly and is the fastest-growing drugresistant organism in Europe in terms of morbidity and as mortality [2]. 40 different KPC variants have been described, with KPC-2 and KPC-3 being the most frequently reported ones globally [3]
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