PIN46 CONTRASTING AVAILABLE THERAPY FOR PATIENTS WITH LIMITED OPTIONS DUE TO EXTREMELY DRUG-RESISTANCE BACTERIA WITH A NOVEL OPTION FOR COMPLICATED NOSOCOMIAL INFECTIONS

Abstract

Appraise the economic value of introducing a novel antimicrobial in the Mexican Healthcare System for hospitalized patients with limited treatment options due to infections caused by aerobic Gram-negative organisms resistant to available therapies. An economic model was developed comparing the available therapy for patients with limited options, colistin+carbapenem, with ceftazidime/avibactam (CAZ-AVI), an extended-spectrum cephalosporin along with a novel non-β-lactam β-lactamase inhibitor. Outcomes were measured as proportion of cured patients and proportion of alive patients, considering the critical need of new treatments due to antimicrobial resistance. The cost-effectiveness model was performed with an institutional perspective. Mexican public institutional costs and resource use for disease and its complications, including adverse events treatments, were considered. The time horizon in the model considered average length of treatment for CAZ-AVI and the assessed comparator. Deterministic and probabilistic sensitive analyses were conducted in order to evaluate robustness of clinical and economic outcomes. CAZ-AVI offers an incremental clinical cure cost of –USD 1,578 (USD 3,861 – USD 5,439) in the treatment of complicated infections; the proportion of cured patients being 85% versus 40% for CAZ-AVI and colistin+carbapenem respectively, this results in a lower cost per healed patient of USD 4,542 with CAZ-AVI versus USD 13, 596 with colistin+carbapenem. Also, CAZ-AVI is a dominant alternative considering overall survival of 92% with USD 4,196 cost per live patient versus 55% with USD 9,888 of colistin+carbapenem cost. CAZ-AVI is a cost-saving alternative in the treatment of complicated infections caused by multidrug-resistant pathogens in patients with limited treatment options due to estimated higher cure and survival rates and a lower rate of adverse events (i.e. renal failure). Due to increasing antimicrobial resistance, the adequate use of ceftazidime/avibactam represents a feasible alternative for Mexican public sector following WHO recommendations in the Global Action Plan on Antimicrobial Resistance.