Naik Jaesh, Puzniak Laura, Critchlow Simone, Elsea David, Dillon Ryan James, Yang Joe
BresMed Health Solutions Ltd, Sheffield, UK.
Merck & Co., Inc., Kenilworth, NJ, USA.
Infect Dis Ther. 2021 Jun;10(2):939-954. doi: 10.1007/s40121-021-00436-4. Epub 2021 Apr 9.
The clinical efficacy and safety of ceftolozane/tazobactam for the treatment of ventilated hospital-acquired bacterial pneumonia (vHABP) and ventilator-associated bacterial pneumonia (VABP) has been demonstrated in the phase III randomised controlled trial ASPECT-NP. However, there are no published data on the cost-effectiveness of ceftolozane/tazobactam for vHABP/VABP. These nosocomial infections are associated with high rates of morbidity and mortality, and are increasingly complicated by growing rates of resistance and the inappropriate use of antimicrobials. This study is to assess the cost-effectiveness of ceftolozane/tazobactam compared with meropenem for the treatment of vHABP/VABP in a US hospital setting.
A short-term decision tree followed by a long-term Markov model was developed to estimate lifetime costs and quality-adjusted life-years associated with ceftolozane/tazobactam and meropenem in the treatment of patients with vHABP/VABP. Pathogen susceptibility and clinical efficacy were informed by the Program to Assess Ceftolozane/Tazobactam Susceptibility (PACTS) database and ASPECT-NP, respectively. A US healthcare sector perspective was adopted, capturing direct costs borne by third-party payers or integrated health systems, and direct health effects for patients.
In the confirmed treatment setting (post-susceptibility results), the incremental cost-effectiveness ratio for ceftolozane/tazobactam compared to meropenem was US$12,126 per quality-adjusted life-year (QALY); this reduced when used in the early treatment setting (before susceptibility results) at $4775/QALY.
Ceftolozane/tazobactam represents a highly cost-effective treatment option for patients with vHABP/VABP versus meropenem when used in either the confirmed or early treatment setting; with increased cost-effectiveness shown in the early setting.
在III期随机对照试验ASPECT-NP中已证实头孢洛扎/他唑巴坦治疗通气相关性医院获得性细菌性肺炎（vHABP）和呼吸机相关性细菌性肺炎（VABP）的临床疗效和安全性。然而，尚无关于头孢洛扎/他唑巴坦治疗vHABP/VABP的成本效益的公开数据。这些医院感染与高发病率和死亡率相关，并且因耐药率上升和抗菌药物使用不当而日益复杂。本研究旨在评估在美国医院环境中，与美罗培南相比，头孢洛扎/他唑巴坦治疗vHABP/VABP的成本效益。
构建了一个短期决策树，随后建立了一个长期马尔可夫模型，以估计与头孢洛扎/他唑巴坦和美罗培南治疗vHABP/VABP患者相关的终生成本和质量调整生命年。病原体敏感性和临床疗效分别来自评估头孢洛扎/他唑巴坦敏感性（PACTS）数据库和ASPECT-NP。采用美国医疗保健部门的视角，涵盖第三方支付者或综合卫生系统承担的直接成本以及对患者的直接健康影响。
在确诊治疗环境（药敏结果后）中，与美罗培南相比，头孢洛扎/他唑巴坦的增量成本效益比为每质量调整生命年（QALY）12,126美元；在早期治疗环境（药敏结果前）中使用时，该比值降至4775美元/QALY。
对于vHABP/VABP患者，在确诊或早期治疗环境中使用时，头孢洛扎/他唑巴坦与美罗培南相比是一种具有高成本效益的治疗选择；在早期治疗环境中成本效益更高。
