RESUMO
Ceftazidime/avibactam (CAZ-AVI) is a novel, fixed-dose combination antibiotic that has been approved in Europe and the United States for patients with complicated urinary tract infections (cUTIs) based on results of a Phase III, randomized, comparative study (RECAPTURE study). The present analysis evaluated cost-effectiveness of CAZ-AVI as an empirical treatment for hospitalized patients with cUTIs from the Italian publicly funded healthcare (third-party payer) perspective. A sequential, patient-level simulation model was developed that followed the clinical course of cUTI and generated 5000 pairs of identical patients (CAZ-AVI or imipenem as empirical treatment). The model included additional impact of resistant pathogens; patients who did not respond to empirical treatment were switched to second-line treatment of colistin+high dose carbapenem in both groups. The time horizon of the model was five years, with an annual discount rate of 3% applied to both costs and quality-adjusted life-years (QALYs). The analysis demonstrated that an intervention sequence (CAZ-AVI followed by colistin+high dose carbapenem) compared with a comparator sequence (imipenem followed by colistin+high dose carbapenem) was associated with a net incremental cost of 1015 per patient but provided better health outcomes in terms of clinical cure (97.65% vs. 91.08%; ∆â¯=â¯6.57%), shorter hospital stays (10.65 vs. 12.55 days; ∆â¯=â¯1.90 days), and QALYs gained per patient (4.190 vs. 4.063; ∆â¯=â¯0.126). The incremental cost-effectiveness ratio was 8039/QALY, which is well below the willingness-to-pay threshold of 30 000/QALY in Italy. The results showed that CAZ-AVI is expected to be a cost-effective treatment compared with imipenem for cUTI in Italy.
Assuntos
Antibacterianos/economia , Compostos Azabicíclicos/economia , Ceftazidima/economia , Análise Custo-Benefício/métodos , Imipenem/economia , Tempo de Internação/economia , Infecções Urinárias/tratamento farmacológico , Antibacterianos/uso terapêutico , Compostos Azabicíclicos/uso terapêutico , Carbapenêmicos/economia , Carbapenêmicos/uso terapêutico , Ceftazidima/uso terapêutico , Colistina/economia , Colistina/uso terapêutico , Combinação de Medicamentos , Europa (Continente) , Bactérias Gram-Negativas/efeitos dos fármacos , Humanos , Imipenem/uso terapêutico , Programas Nacionais de Saúde , Estados Unidos , Infecções Urinárias/microbiologiaRESUMO
OBJECTIVE: ⢠To assess the economic value of targeted therapies as first-line metastatic renal cell carcinoma (mRCC) treatment in the US and Sweden by indirect comparison of survival data. METHODS: ⢠A Markov model simulated disease progression, adverse events and survival with sunitinib vs sorafenib in the US and bevacizumab plus interferon-α (IFN-α) in both countries. ⢠Results, in life-years (LYs), progression-free LYs (PFLYs), quality-adjusted LYs (QALYs) gained and treatment costs (2008 USD) were obtained through deterministic and probabilistic analyses over the patient's lifetime. RESULTS: ⢠Sunitinib was more effective and less costly than sorafenib (gains of 0.52 PFLYs, 0.16 LYs and 0.17 QALYs and savings/patient of $13,576 in the US) and bevacizumab plus IFN-α (gains of 0.19 PFLYs, 0.23 LYs and 0.16 QALYs in both countries and savings/patient of $67,798 and $47,264 in the US and Sweden, respectively). ⢠Results were most influenced by hazard ratios for progression-free and overall survival and treatment costs, making results generalizable across other countries if relative costs were to fall within the ranges of those in the US and Sweden. CONCLUSION: ⢠The present analyses suggest that first-line mRCC treatment with sunitinib is a cost-effective alternative to sorafenib and bevacizumab plus IFN-α.