PIN16 COST-EFFECTIVENESS OF CEFTAZIDIME-AVIBACTAM + METRONIDAZOLE AS A FIRST-LINE TREATMENT IN PATIENTS WITH COMPLICATED INTRA-ABDOMINAL INFECTIONS IN TAIWAN

Abstract

This study evaluates the cost-effectiveness of ceftazidime-avibactam (CAZ-AVI), a novel combination antibiotic, as a first-line therapy for patients in Taiwan with cIAI caused by either E. coli, K. pneumonia, or P. aeruginosa. A previously developed patient-level simulation model evaluating the cost-effectiveness of CAZ-AVI in cIAIs, complicated urinary tract infections, and hospital-acquired pneumonia, was localized to Taiwan. cIAI-causing pathogens E. coli, K. pneumonia, or P. aeruginosa were included in the model using prevalence rates from the literature. CAZ-AVI + metronidazole was evaluated as a first-line therapy and compared against meropenem. In both arms, colistin + high dose meropenem (HDM) + tigecycline was the second-line therapy for all pathogens except P. aeruginosa, where colistin + HDM was used. Pathogen-specific resistance and effectiveness rates for each antibiotic were sourced from the RECLAIM 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). CAZ-AVI + metronidazole was cost-effective as a first-line therapy compared to meropenem for patients with cIAI with an incremental cost-effectiveness ratio of NT$1,376,211 per quality-adjusted life-year (QALY) gained, respectively. Incremental total costs and QALYs were NT$78,683 and 0.06, respectively. Incremental costs were driven by an increase in antibiotic costs (NT$85,981) and partially offset by a reduction in hospitalization costs (-NT$6,888) and recurrence costs (-NT$411). CAZ-AVI + metronidazole reduced the percentage of patients resistant to first-line therapy by 6.9% and increased the percentage of patients with an overall clinical cure by 3.04%. CAZ-AVI was cost-effective as a first-line intervention for patients with cIAI caused by E. coli, K. pneumonia, or P. aeruginosa in Taiwan.