Programme in Health Services and Systems Research, Duke-NUS Medical School, National University of Singapore, Singapore.
Sunpasitthiprasong Hospital, Ubon Ratchathani, Thailand.
Lancet Glob Health. 2024 Dec;12(12):e2059-e2067. doi: 10.1016/S2214-109X(24)00327-9. Epub 2024 Nov 4.
The REGARD-VAP trial showed that individualised shortened antibiotic therapy was non-inferior to usual care for mortality and pneumonia recurrence in patients with ventilator-associated pneumonia (VAP). We aimed to assess the cost-effectiveness of an individualised shortened antibiotic therapy approach in this planned economic analysis.
REGARD-VAP was a phase 4, multicentre, open-label, randomised trial to assess a short-course antibiotic treatment strategy for treatment of VAP. In this planned economic analysis, we fitted a decision tree with data from the REGARD-VAP trial to estimate the cost-effectiveness of individualised short-course therapy for VAP, compared to usual care from the health system perspective, in Nepal, Singapore, and Thailand. Incremental cost-effectiveness ratios (ICERs) and incremental net monetary benefits with 95% uncertainty intervals (UIs) were reported against relevant willingness-to-pay thresholds. Parameter uncertainties were evaluated using scenario analyses. A value of information analysis was conducted.
Adopting individualised short-course therapy was cost-effective for Nepal (ICER=US$1086; percentage cost-effectiveness=50·3%), Singapore (ICER=-$6069; percentage cost-effectiveness=55·2%), and Thailand (ICER=$263; percentage cost-effectiveness=60·5%). The associated incremental net monetary benefits were $41 (95% UI -2308 to 2390) in Nepal, $5156 (-45 805 to 56 117) in Singapore, and $804 (-6245 to 7852) in Thailand. Value of information analysis showed that reducing uncertainties for mortality probabilities, bed-day costs, and variable costs were valuable for decision making.
We found that an individualised short-course antibiotics strategy in patients with VAP is likely to be cost-effective in high-income, middle-income, and low-income settings, although with evident uncertainty. Considered alongside the positive externalities of reduced antimicrobial use, our findings foster confidence in policy makers contemplating adoption of short-course antibiotics.
UK Medical Research Council, Singapore National Medical Research Council, and Wellcome Trust.
REGARD-VAP 试验表明，个体化缩短抗生素治疗与常规治疗相比，在呼吸机相关性肺炎（VAP）患者的死亡率和肺炎复发方面非劣效。我们旨在评估个体化缩短抗生素治疗方法在这项计划经济分析中的成本效益。
REGARD-VAP 是一项 4 期、多中心、开放标签、随机试验，旨在评估 VAP 的短期抗生素治疗策略。在这项计划经济分析中，我们根据 REGARD-VAP 试验的数据拟合决策树，以评估个体化短程治疗 VAP 的成本效益，与尼泊尔、新加坡和泰国的常规护理相比。增量成本效益比（ICER）和增量净货币效益（95%不确定性区间[UI]）根据相关意愿支付阈值进行报告。使用情景分析评估参数不确定性。进行了信息价值分析。
个体化缩短疗程治疗在尼泊尔（ICER=1086 美元；成本效益百分比=50.3%）、新加坡（ICER=-6069 美元；成本效益百分比=55.2%）和泰国（ICER=263 美元；成本效益百分比=60.5%）具有成本效益。尼泊尔的增量净货币效益为 41 美元（95%UI-2308 至 2390），新加坡为 5156 美元（-45805 至 56117），泰国为 804 美元（-6245 至 7852 美元）。信息价值分析表明，降低死亡率概率、床位日成本和可变成本的不确定性对决策具有重要价值。
我们发现，在高收入、中等收入和低收入环境中，针对 VAP 患者的个体化短程抗生素策略可能具有成本效益，尽管存在明显的不确定性。考虑到减少抗菌药物使用的外部性，我们的发现增强了决策者考虑采用短程抗生素的信心。
英国医学研究理事会、新加坡国家医学研究理事会和惠康信托基金会。
