Abstract
Complicated intra-abdominal infections (cIAIs) and hospital-acquired pneumonia (HAP) including ventilator-associated pneumonia (VAP) are infections subject to the increasing antimicrobial resistance. This study evaluates the cost-effectiveness of ceftazidime-avibactam (CAZ-AVI) a novel combination antibiotic in China for cIAI or HAP/VAP infections caused by carbapenem-resistant Enterobacteriaceae (CRE). A previously developed patient-level simulation model was localized to China. CAZ-AVI was evaluated as a first-line antibiotic and compared against meropenem for both the cIAI and HAP/VAP scenarios. CAZ-AVI was paired with metronidazole in patients with CRE cIAI. The second-line treatments for both comparator arms were colistin + tigecycline + high dose meropenem and colistin + high dose carbapenem (CBP) for cIAI and HAP/VAP, respectively. The resistance rate for CAZ-AVI was 2.5% for both indications. Resistance to meropenem was 84.91% in cIAI, and 81.83% in HAP/VAP. Effectiveness rates from the core model were weighted according to the prevalence of pathogens in the data used to calculate resistance rates. Costs for antibiotics, hospitalization (ICU and general ward), adverse events, and recurrence were localized to China. Costs and benefits were discounted at 3%, over the 5-year time horizon. CAZ-AVI was cost-effective in both cIAI and HAP/VAP for infections caused by CRE. In CRE cIAI, CAZ-AVI + metronidazole resulted in 0.59 additional QALYs and ¥16,341 incremental costs compared to meropenem for an ICER of ¥27,577 per additional QALY gained. For patients with CRE HAP/VAP CAZ-AVI resulted in 0.83 additional QALYs and ¥21,683 additional costs compared to meropenem for an ICER of ¥26,006 per additional QALY gained. Overall clinical cure was 28.80% and 27.31% higher for the CAZ-AVI arm compared to the meropenem arm in CRE cIAI and HAP/VAP, respectively. CAZ-AVI is a cost-effective alternative to the standard of care as a first-line antibiotic for patients with CRE cIAI or HAP/VAP in China.
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