Economic evaluation of ceftazidime-avibactam vs. polymyxin B for treatment of hospital-acquired and ventilator-associated bacterial pneumonia

IF 3 4区医学 Q2 INFECTIOUS DISEASES

Brazilian Journal of Infectious Diseases Pub Date : 2025-05-14 DOI:10.1016/j.bjid.2025.104545

Jessica Matuoka , Daniela Vianna Pachito , Filipe Piastrelli , Lorena Cristina Correa Fehlberg , Haliton Alves de Oliveira Junior

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引用次数: 0

Abstract

Ventilator-associated pneumonia is one of the most common infections in Intensive Care Units (ICU). It is frequently caused by multidrug-resistant pathogens (including carbapenems) and is an important health issue. It may result in severe clinical consequences, with higher healthcare utilization and high economic burden. Timely and appropriate treatment is key to obtaining better outcomes and allocational efficiency. Currently, the treatment options for carbapenem-resistant pathogen infections are limited, usually based on polymyxin, aminoglycosides, or combination therapy, as well as novel antibiotic therapies including Ceftazidime/Avibactam (CAZ-AVI). CAZ-AVI has shown activity against gram-negative pathogens and is currently used for the treatment of Ventilator-Associated Pneumonia (VAP). To better inform healthcare professionals and help promote a rational use of antibiotic therapy, a cost-effectiveness analysis was conducted to compare the cost-effectiveness of CAZ-AVI versus polymyxin B in ICU patients with VAP from the Brazilian National Supplementary Health Agency perspective over a 5-year time horizon. CAZ-AVI had higher total costs and resulted in more Quality-Adjusted Life Years (QALY) gained when compared with polymyxin B. At a willingness-to-pay threshold of BRL 40,000.00/QALY gained, CAZ-AVI was the cost-effective strategy (ICER: BRL 35,298.65/QALY gained). Nephrotoxicity in patients treated with polymyxin B, hospitalization utility, and treatment duration were the variables that most influenced the results. In the probabilistic sensitivity analysis, CAZ-AVI was cost-effective in 55 %–89 % of the interactions. The evidence suggests that CAZ-AVI results in lower mortality and nephrotoxicity rates, which might have contributed to more QALYs gained and a favorable ICER, despite the higher costs. This study was registered on the Open Science Framework database (Protocol https://doi.org/10.17605/OSF.IO/SP2EJ).

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头孢他啶-阿维巴坦与多粘菌素B治疗医院获得性和呼吸机相关细菌性肺炎的经济评价

呼吸机相关性肺炎是重症监护病房（ICU）最常见的感染之一。它通常由耐多药病原体（包括碳青霉烯类）引起，是一个重要的健康问题。它可能导致严重的临床后果，医疗保健利用率高，经济负担高。及时和适当的治疗是获得更好的结果和分配效率的关键。目前，碳青霉烯耐药病原体感染的治疗选择有限，通常基于多粘菌素、氨基糖苷类或联合治疗，以及新型抗生素治疗，包括头孢他啶/阿维巴坦（CAZ-AVI）。CAZ-AVI已显示出抗革兰氏阴性病原体的活性，目前用于治疗呼吸机相关性肺炎（VAP）。为了更好地告知医疗保健专业人员并帮助促进抗生素治疗的合理使用，从巴西国家补充卫生机构的角度进行了成本-效果分析，比较CAZ-AVI与多粘菌素B在ICU VAP患者5年时间内的成本-效果。与多粘菌素b相比，CAZ-AVI具有更高的总成本，并且获得了更多的质量调整生命年（QALY）。在支付意愿阈值为40,000.00巴西雷亚尔/获得的QALY时，CAZ-AVI是具有成本效益的策略（ICER: 35,298.65巴西雷亚尔/获得的QALY）。多粘菌素B治疗患者的肾毒性、住院效用和治疗时间是影响结果最大的变量。在概率敏感性分析中，CAZ-AVI在55% - 89%的相互作用中具有成本效益。有证据表明CAZ-AVI导致较低的死亡率和肾毒性率，这可能有助于获得更多的QALYs和有利的ICER，尽管成本较高。本研究已在开放科学框架数据库（协议https://doi.org/10.17605/OSF.IO/SP2EJ）上注册。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Brazilian Journal of Infectious Diseases 医学-传染病学

CiteScore

5.50

自引率

0.00%

发文量

925

审稿时长

41 days

期刊介绍： The Brazilian Journal of Infectious Diseases is the official publication of the Brazilian Society of Infectious Diseases (SBI). It aims to publish relevant articles in the broadest sense on all aspects of microbiology, infectious diseases and immune response to infectious agents. The BJID is a bimonthly publication and one of the most influential journals in its field in Brazil and Latin America with a high impact factor, since its inception it has garnered a growing share of the publishing market.