Costo-efficacia di IMI/CIL/REL rispetto a CMS+IMI per il trattamento di infezioni batteriche Gram-negative non sensibili ai carbapenemi

Abstract

Objective:: The objective of this analysis was to evaluate the cost-effectiveness of imipenem/cilastatin/relebactam compared to colistin-imipenem in the treatment of hospitalized patients with Gram-negative bacterial infections caused by imipenem-resistant pathogens. The perspective was both that of the National Health Service (NHS) and the social one.

Methodology:: A mixed model was developed to simulate a cohort of patients capable of highlighting the impacts of the disease on the quality of life and the absorption of economic resources of the patients in analysis. Modelled patients were those with hospital-acquired bacterial pneumonia/ventilator-associated bacterial pneumonia (HABP/VABP), complicated intra-abdominal infection (cIAI) or complicated urinal tract infection (cUTI) caused by carbapenem-resistant Gram-negative (GN) pathogens. The model begins with a short-term decision tree describing possible treatment routes and outcomes for patients during the hospitalization period. Patients who are healed in the decision tree enter the long-term Markov model, designed to capture the follow-up costs and health-related quality of life (HRQL) of patients healed over their lifetime.

Results:: The analysis, conducted on a hypothetical cohort of 1,000 patients, highlights how the use of imipenem/cilastatin/relebactam is advantageous both in terms of diagnosis and treatment in the short term and in terms of cost-effectiveness. In fact, it is dominant compared to colistin-imipenem both in the NHS and in the social perspective since, compared to an average saving of € 2,800.15 and € 3,174.63 respectively, it would generate an increase of 4.76 years of life and of 4.12 QALYs per patient.

Fig. 1 -

Struttura del modello di costo-efficacia. A) Albero decisionale; B) Modello di Markov.

Fig. 2 -

Risultati di efficacia nel breve periodo.

Fig. 3 -

Grafico Tornado analisi di sensitività deterministica – Prospettiva SSN.

Fig. 4 -

Grafico Tornado analisi di sensitività deterministica – Prospettiva sociale.

Fig. 5 -

Analisi di sensibilità probabilistica – Prospettiva SSN.

Fig. 6 -

Analisi di sensibilità probabilistica – Prospettiva sociale.