OBJECTIVES

To compare the cost-effectiveness of ceftazidime-avibactam (CAZ-AVI) to current treatments for hospital acquired pneumonia and ventilator associated pneumonia (HAP/VAP) due to carbapenem resistant Klebsiella Pneumonia in Argentina.

METHODS

A decision tree model was developed to estimate the clinical cure (CC), survival and costs for each alternative from the payer perspective. The time horizon was the duration of the therapy. The comparators were Colistin/Tigecycline, Colistin/high dose carbapenem, Colistin/amikacin and amikacin/ high dose carbapenem. The model was populated using local epidemiological data. Cure rates were based on clinical trials, published data and local expert opinion. Hospital length of stay associated with treatment cures/failures was derived from clinical trials of CAZ-AVI. Costs of drugs were obtained from ANMAT's National Drug Vademecum. Costs of hospital stay were based on tariffs from private institutions of Argentina. Each treatment option was compared with CAZ-AVI. Costs were expressed in 2020 US-dollars (exchange rate: $1=AR$69.64, July 2020). Deterministic and probabilistic sensitivity analyses assessed the robustness of results.

RESULTS

The cost-effectiveness analysis showed that in patients with CRE HAP/VAP the use of CAZ-AVI was a dominant treatment option at a willingness to pay threshold of $10,006 (1 GDP/capita) compared to Colistin/Tigecycline (ICER=-$916/CC), Colistin/high dose carbapenem (ICER=-$940/CC), Colistin/amikacin (ICER=-$1,268/CC) and amikacin/ high dose carbapenem (ICER=-$3,405/CC). Deterministic and probabilistic sensitivity analyses show that results are robust to all scenarios.

CONCLUSIONS

The cost-effective analysis has demonstrated that CAZ-AVI appears to be a dominant treatment in patients with hospital acquired pneumonia and ventilator associated pneumonia (HAP/VAP) due to Carbapenem resistant Klebsiella Pneumonia in Argentina.