Prabhu Vimalanand S, Solomkin Joseph S, Medic Goran, Foo Jason, Borse Rebekah H, Kauf Teresa, Miller Benjamin, Sen Shuvayu S, Basu Anirban
Merck & Co., Inc., Kenilworth, NJ USA.
Center for Observational and Real World Evidence (CORE), Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, NJ 07033 USA.
Antimicrob Resist Infect Control. 2017 Oct 27;6:107. doi: 10.1186/s13756-017-0264-2. eCollection 2017.
The prevalence of antimicrobial resistance among gram-negative pathogens in complicated intra-abdominal infections (cIAIs) has increased. In the absence of timely information on the infecting pathogens and their susceptibilities, local or regional epidemiology may guide initial empirical therapy and reduce treatment failure, length of stay and mortality. The objective of this study was to assess the cost-effectiveness of ceftolozane/tazobactam + metronidazole compared with piperacillin/tazobactam in the treatment of hospitalized US patients with cIAI at risk of infection with resistant pathogens.
We used a decision-analytic Monte Carlo simulation model to compare the costs and quality-adjusted life years (QALYs) of persons infected with nosocomial gram-negative cIAI treated empirically with either ceftolozane/tazobactam + metronidazole or piperacillin/tazobactam. Pathogen 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 with cIAIs in medical centers in the USA from 2011 to 2013. Susceptibility to initial therapy was based on the measured susceptibilities reported in the PACTS database determined using standard broth micro-dilution methods as described by the Clinical and Laboratory Standards Institute (CLSI).
Our model results, with baseline resistance levels from the PACTS database, indicated that ceftolozane/tazobactam + metronidazole dominated piperacillin/tazobactam, with lower costs ($44,226/patient vs. $44,811/patient respectively) and higher QALYs (12.85/patient vs. 12.70/patient, respectively). Ceftolozane/tazobactam + metronidazole remained the dominant choice in one-way and probabilistic sensitivity analyses.
Based on surveillance data, ceftolozane/tazobactam is more likely to be an appropriate empiric therapy for cIAI in the US. Results from a decision-analytic simulation model indicate that use of ceftolozane/tazobactam + metronidazole would result in cost savings and improves QALYs, compared with piperacillin/tazobactam.
复杂腹腔内感染（cIAIs）中革兰氏阴性病原体的抗菌药物耐药性患病率有所上升。在缺乏关于感染病原体及其药敏性的及时信息的情况下，当地或区域流行病学情况可指导初始经验性治疗，并降低治疗失败率、缩短住院时间和降低死亡率。本研究的目的是评估头孢洛扎/他唑巴坦+甲硝唑与哌拉西林/他唑巴坦相比，在治疗有耐药病原体感染风险的美国住院cIAI患者中的成本效益。
我们使用决策分析蒙特卡洛模拟模型，比较接受头孢洛扎/他唑巴坦+甲硝唑或哌拉西林/他唑巴坦经验性治疗的医院获得性革兰氏阴性cIAI感染患者的成本和质量调整生命年（QALYs）。病原体分离株是从评估头孢洛扎/他唑巴坦敏感性计划（PACTS）数据库中随机抽取的，该数据库是一个监测数据库，收集了2011年至2013年美国医疗中心cIAIs患者的非重复细菌分离株。对初始治疗的敏感性基于PACTS数据库中报告的使用临床和实验室标准协会（CLSI）描述的标准肉汤微量稀释法测定的药敏性。
我们的模型结果基于PACTS数据库的基线耐药水平，表明头孢洛扎/他唑巴坦+甲硝唑优于哌拉西林/他唑巴坦，成本更低（分别为44,226美元/患者和44,811美元/患者），QALYs更高（分别为12.85/患者和12.70/患者）。在单向和概率敏感性分析中，头孢洛扎/他唑巴坦+甲硝唑仍然是首选。
根据监测数据，头孢洛扎/他唑巴坦在美国更有可能是cIAI的合适经验性治疗药物。决策分析模拟模型的结果表明，与哌拉西林/他唑巴坦相比，使用头孢洛扎/他唑巴坦+甲硝唑可节省成本并提高QALYs。
