Cost-effectiveness Analysis Comparing Ceftazidime/Avibactam With Standard of Care in the Treatment of Hospital and Ventilator-Acquired Pneumonia in the Philippines.

Objectives: Ceftazidime/avibactam (CAZ-AVI) is a novel antibiotic approved for hospital-acquired pneumonia, including ventilator-associated pneumonia (HAP/VAP). This study evaluated the cost-effectiveness of CAZ-AVI as second-line therapy, after meropenem, in patients with HAP/VAP. Its economic benefits are assessed against available second-line comparators from the societal perspective in the Philippines.

Methods: A patient-level, sequential simulation model of the HAP/VAP clinical course was developed using Excel. Data inputs were collected between June 2023 and August 2023. Costs and benefits to society were discounted at 7% over a 5-year time horizon. Clinical data were sourced from the REPROVE trial, other published literature and expert opinion. The model also incorporated the impact of resistant pathogens using global and local surveillance data, as well as expert insights.

Results: The base-case analysis demonstrated that the intervention sequence (empiric meropenem followed by CAZ-AVI) had a higher clinical cure rate (+9.82%) versus the comparator sequence (empiric meropenem followed by colistin + high-dose meropenem). This led to a shorter hospital stay (-1.57 days per patient) and incremental quality-adjusted life-years gains (+0.08) per patient. The intervention sequence also reduced costs by 218 405 PHP per patient, yielding an incremental cost-effectiveness ratio of -2 859 584 PHP/quality-adjusted life-year. The incremental cost-effectiveness ratio was robust across a range of sensitivity and scenario analyses.

Conclusions: CAZ-AVI is expected to be a highly cost-effective second-line treatment compared with colistin + high-dose meropenem from the societal perspective in the Philippines.