Methods: A decision-tree model was developed. Results are presented from a U.S. hospital perspective. Clinical parameters were sourced from published data. Resource use included drug acquisition, drug administration, adverse events, hospitalization and empiric therapy failure. Costs were expressed in 2014 U.S. dollars. Results were presented as costs per life-year gained. One-way sensitivity analyses were conducted to determine the impact of variability in base-case point estimates on model outcomes. Probabilistic analyses were also conducted by means of 10,000 Monte Carlo simulations.
Results: Model results indicated that use of minocycline may be cost-effective when used after positive AB culture compared with MER, or when used after prior carbapenem failure compared to TIG or COL. MIN was associated with an estimated incremental gain of 3.38 life years over MER, and associated cost savings of $2,099 (dominant). MIN was associated with an estimated incremental gain of 3.12 life years over colistin COL, and cost savings of $1,599 (dominant). MIN was associated with a gain in life years of 2.89 compared to TIG, however was associated with additional costs of $1,200, resulting in an incremental cost of $415 per life year gained. Sensitivity analyses indicated that length of stay (LOS) is a key cost driver. In probabilistic sensitivity analyses, MIN was less costly and more effective compared to MER in 96% of simulations. MIN was less costly and more effective in 87% and 25% of simulations when compared to COL and TIG, respectively.
Conclusion: In this hospital model, MIN is a cost-effective option for the treatment of MDR AB compared to MER, TIG, or COL; however, further research is needed to reduce uncertainty in the analysis and confirm data around outcomes associated with various treatment strategies.
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W. Fan, The Medicines Company: Employee and Shareholder , Salary
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K. Sulham, The Medicines Company: Employee and Shareholder , Salary