OBJECTIVES:

Antimicrobial resistance (AMR) represents a significant and growing health crisis, especially in Greece, where rates are among the highest in Europe. Ceftazidime-avibactam has been approved in Europe to treat a broad range of gram-negative bacterial infections, including complicated intra-abdominal, complicated urinary tract infections, and hospital-acquired pneumonia, which pose an increasing threat to public health. This cost-effectiveness analysis aimed at evaluating ceftazidime-avibactam in the management of gram-negative hospital-acquired infections (HAIs) in Greece.

METHODS:

The cost-effectiveness analysis of ceftazidime-avibactam was adapted to the Greek setting from a previously published dynamic transmission model of AMR. The model considered HAIs due to Escherichia coli, Klebsiella spp and Pseudomonas aeruginosa. The base case analysis included ceftazidime-avibactam versus meropenem as a first-line treatment in a two-line, indication-specific, treatment strategy. Two alternative scenarios evaluated ceftazidime-avibactam against meropenem-vaborbactam and imipenem-cilastatin-relebactam as first-line treatments based on their licensed indications. Inputs for incidence, efficacy, resistance, adverse events, and costs were sourced from the literature and expert opinion. A ten-year infection transmission horizon was considered, where quality adjusted life years (QALYs) were estimated over a lifetime, using a willingness-to-pay threshold of €30,000–€35,000 per QALY. Costs and QALYs were discounted at a rate of 3.5%.

RESULTS:

The base-case considered 27,508 modelled annual infections, over 10 years. The intervention strategy including ceftazidime-avibactam had an incremental cost-effectiveness ratio of €471.16 per QALY. Ceftazidime-avibactam was associated with an additional 456,062 QALYs, at an incremental cost of €214,879,039, with drug costs being partially offset by savings in hospitalisation and adverse event costs. Ceftazidime-avibactam was dominant in both scenarios where comparator arms used meropenem-vaborbactam and imipenem-cilastatin-relebactam as the first-line treatment.

CONCLUSIONS:

Ceftazidime-avibactam demonstrated considerable cost-effectiveness against comparators for treating gram-negative HAIs, in Greece. As the value of new antimicrobials extend beyond those captured within this model, future methods should seek to estimate this additional value.