1885. Cost-Effectiveness of Ceftazidime-Avibactam Compared to Colistin for Treatment of Carbapenem-Resistant Enterobacteriaceae Bacteremia and Pneumonia
Session: Poster Abstract Session: Antimicrobial Stewardship: Potpourri
Saturday, October 6, 2018
Room: S Poster Hall
Posters
  • CRE_CEA_ID_Week2018_Final-.pdf (390.9 kB)
  • Background: Ceftazidime/avibactam (CAZ/AVI) may improve outcomes among patients with carbapenem-resistant Enterobacteriaceae (CRE) infections. However, the cost-effectiveness of CAZ/AVI  is unknown.

    Methods: We used a decision analytic model to estimate the health and economic consequences of CAZ/AVI-based therapy compared to colistin-based therapy (COL) for a hypothetical cohort of patients with CRE pneumonia and bacteremia over a 1-year time horizon. Model inputs were from published sources and included CRE mortality with COL (41%), CAZ/AVI’s absolute risk reduction (ARR) in CRE mortality (23%), daily cost of CAZ/AVI ($1080), risk of NTX with COL (42%), probability of discharge to long-term care (LTC) following CRE infection (56%), and improved odds of discharge home with CAZ/AVI compared to COL (1.8). Outcomes included quality adjusted life-years (QALYs), costs, and incremental cost-effectiveness ratios (ICER; $/QALY). 1-way and probabilistic sensitivity analyses were performed and ICERs were compared to willingness to pay standards of $100,000/QALY and $150,000/QALY.

    Results: The ICER for CAZ/AVI compared to COL was $110,300/QALY (Table). In 1-way sensitivity analyses, CAZ/AVI had an ICER <$100,000/QALY when the ARR in CRE mortality was >29%, the odds of discharge home with CAZ/AVI was > 1.9, CAZ/AVI’s daily cost was <$775, quality of life weight following discharge home was >0.92, risk of NTX with COL was >49% or annual costs of LTC were <$75,890. CAZ/AVI had an ICER >$150,000/QALY when CAZ/AVI’s ARR in CRE mortality was <12%, the odds of discharge home with CAZ/AVI compared with COL was <1.3, or the quality of life weight following discharge home was <0.61. In probabilistic sensitivity analysis, CAZ/AVI was the optimal strategy in 40% and 76% of simulations at willingness to pay thresholds of $100,000/QALY and $150,000/QALY, respectively (Figure).

    Conclusion: CAZ/AVI is appropriate from an economic perspective based on efficacy data from observational studies and willingness to pay standards in the US.

    Strategy

    Cost (per 1,000 CRE infections)

    Incremental cost

    Total QALYs (per 1,000 CRE infections)

    Incremental QALYs

    ICER ($/QALY)

    Colistin

    $22,200,170

    ----

    378

    ----

    ----

    Ceftazidime-Avibactam  

    $41,311,296

    $19,111,126

    551

    173

    110,300

    Maroun Sfeir, MD, MPH1, Michael Satlin, MD, MS2, David P. Calfee, MD, MS3 and Matthew S. Simon, MD, MS3, (1)Medicine, Weill Cornell Medicine/ New York Presbyterian Hospital, New York, NY, (2)NewYork-Presbyterian Hospital / Weill Cornell Medical Center, New York, NY, (3)Weill Cornell Medicine, New York, NY

    Disclosures:

    M. Sfeir, None

    M. Satlin, Allergan: Grant Investigator , Research grant .

    D. P. Calfee, None

    M. S. Simon, None

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