PCV155 COST-EFFECTIVENESS OF SECOND-LINE CEFTAZIDIME-AVIBACTAM IN PATIENTS WITH HOSPITAL-ACQUIRED PNEUMONIA INCLUDING VENTILATOR-ASSOCIATED PNEUMONIA IN TAIWAN

Abstract

This study evaluates the cost-effectiveness of ceftazidime-avibactam (CAZ-AVI), a novel combination antibiotic, as first-line therapy for patients with hospital-acquired pneumonia (HAP) including ventilator-associated pneumonia (VAP) in Taiwan. A previously developed patient-level simulation model evaluating the cost-effectiveness of CAZ-AVI in complicated urinary tract infections, complicated intra-abdominal infections, and HAP (incl. VAP), was localized to Taiwan. HAP (incl. VAP)-causing pathogens E. coli, K. pneumonia, E. Cloacae, and P. aeruginosa were included using prevalence rates from the 2015 Taiwan Nosocomial Infections Surveillance report. CAZ-AVI was evaluated as first-line treatment compared against meropenem, second-line treatment with colistin + tigecycline was used for both arms. Pathogen-specific resistance and effectiveness rates for each antibiotic were sourced from a mix of the REPROVE trial, the literature, a report from the Taiwan CDC, or KOL opinion. The model considered costs for antibiotics, hospitalizations, and recurrence, which were localized to Taiwan. Costs and benefits were discounted at 3%, over the 5-year time horizon, and the model took the perspective of the Ministry of Health and Welfare (MoHW). Compared to meropenem arm, the CAZ-AVI was associated with higher incremental costs (NT$82,856), and quality-adjusted life years (QALYs) (0.06) resulting in an incremental cost-effectiveness ratio of NT$1,328,745 per QALY gained. Incremental total costs were primarily driven by higher costs associated with antibiotics (NT$87,073). However, a decrease in incremental hospitalization costs of NT$4,216 was observed. CAZ-AVI reduced the percentage of patients resistant to first-line therapy and mortality by 6.84%, and 1.02%, respectively. The percentage of patients with overall clinical cure increased by 2.56% in the CAZ-AVI arm compared to the meropenem arm. CAZ-AVI was cost-effective as a first-line treatment for patients with HAP (incl. VAP) in Taiwan.