Prabhu Vimalanand, Foo Jason, Ahir Harblas, Sarpong Eric, Merchant Sanjay
a Merck & Co., Inc. , Kenilworth , NJ , USA.
b Mapi Group , Houten , The Netherlands.
J Med Econ. 2017 Aug;20(8):840-849. doi: 10.1080/13696998.2017.1333960. Epub 2017 Jun 8.
An increase in the prevalence of antimicrobial resistance among gram-negative pathogens has been noted recently. A challenge in empiric treatment of complicated intra-abdominal infection (cIAI) is identifying initial appropriate antibiotic therapy, which is associated with reduced length of stay and mortality compared with inappropriate therapy. The objective of this study was to assess the cost-effectiveness of ceftolozane/tazobactam + metronidazole compared with piperacillin/tazobactam (commonly used in this indication) in the treatment of patients with cIAI in UK hospitals.
A decision-analytic Monte Carlo simulation model was used to compare costs (antibiotic and hospitalization costs) and quality-adjusted life years (QALYs) of patients infected with gram-negative cIAI and treated empirically with either ceftolozane/tazobactam + metronidazole or piperacillin/tazobactam. Bacterial isolates were randomly drawn from the Program to Assess Ceftolozane/Tazobactam Susceptibility (PACTS) database, a surveillance database of non-duplicate bacterial isolates collected from patients in the UK infected with gram-negative pathogens. Susceptibility to initial empiric therapy was based on the measured susceptibilities reported in the PACTS database.
Ceftolozane/tazobactam + metronidazole was cost-effective when compared with piperacillin/tazobactam, with an incremental cost-effectiveness ratio (ICER) of £4,350/QALY and 0.36 hospitalization days/patient saved. Costs in the ceftolozane/tazobactam + metronidazole arm were £2,576/patient, compared with £2,168/patient in the piperacillin/tazobactam arm. The ceftolozane/tazobactam + metronidazole arm experienced a greater number of QALYs than the piperacillin/tazobactam arm (14.31/patient vs 14.21/patient, respectively). Ceftolozane/tazobactam + metronidazole remained cost-effective in one-way sensitivity and probabilistic sensitivity analyses.
Economic models can help to identify the appropriate choice of empiric therapy for the treatment of cIAI. Results indicated that empiric use of ceftolozane/tazobactam + metronidazole is cost-effective vs piperacillin/tazobactam in UK patients with cIAI at risk of resistant infection. This will be valuable to commissioners and clinicians to aid decision-making on the targeting of resources for appropriate antibiotic therapy under the premise of antimicrobial stewardship.
近期已注意到革兰氏阴性病原体中抗菌药物耐药性的患病率有所增加。复杂性腹腔内感染（cIAI）经验性治疗面临的一项挑战是确定初始合适的抗生素治疗方案，与不恰当治疗相比，该方案可缩短住院时间并降低死亡率。本研究的目的是评估在英国医院中，头孢洛扎/他唑巴坦联合甲硝唑与哌拉西林/他唑巴坦（该适应症常用药物）相比，治疗cIAI患者的成本效益。
采用决策分析蒙特卡洛模拟模型，比较革兰氏阴性cIAI感染患者经验性使用头孢洛扎/他唑巴坦联合甲硝唑或哌拉西林/他唑巴坦治疗的成本（抗生素和住院成本）及质量调整生命年（QALY）。细菌分离株从评估头孢洛扎/他唑巴坦敏感性计划（PACTS）数据库中随机抽取，该数据库是一个监测数据库，收集了英国感染革兰氏阴性病原体患者的非重复细菌分离株。初始经验性治疗的敏感性基于PACTS数据库中报告的实测敏感性。
与哌拉西林/他唑巴坦相比，头孢洛扎/他唑巴坦联合甲硝唑具有成本效益，增量成本效益比（ICER）为4350英镑/QALY，每位患者节省住院天数0.36天。头孢洛扎/他唑巴坦联合甲硝唑组每位患者的成本为2576英镑，而哌拉西林/他唑巴坦组每位患者为2168英镑。头孢洛扎/他唑巴坦联合甲硝唑组的QALY数量多于哌拉西林/他唑巴坦组（分别为每位患者14.31个 vs 14.21个）。在单向敏感性分析和概率敏感性分析中，头孢洛扎/他唑巴坦联合甲硝唑仍具有成本效益。
经济模型有助于确定cIAI治疗经验性治疗的合适选择。结果表明，在有耐药感染风险的英国cIAI患者中，经验性使用头孢洛扎/他唑巴坦联合甲硝唑与哌拉西林/他唑巴坦相比具有成本效益。这对于决策者和临床医生在抗菌药物管理的前提下，就适当抗生素治疗的资源分配决策提供帮助具有重要价值。
