A review of economic studies evaluating the treatment of ventilator associated pneumonia

Abstract

Background: The clinical definition of Ventilator Associated Pneumonia (VAP) is infection arising during intubation. The topic has attracted considerable interest as a subject of clinical efficacy research. Cost is an important factor when we consider similar options of antibiotic treatments. This study aims to review pharmacoeconomic evaluations made of different VAP treatments and summarize the evaluation methods utilized. Methods: A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). The search strategy was created considering the “PICOS” question, and data was sourced from PubMed, LILACS, Web of Science and Scopus databases, on October 2022. Inclusion and exclusion criterials were applied to filter the results. Findings: The search resulted in 574 studies, of which 12 were used. Of these, four studies evaluated empirical therapy. Antibiotic analysis was performed in eight case studies of Gram-negative infections and four of Gram-positive spectrum. The most prevalent analysis mode was Cost-effectiveness. Cost-minimization, Cost-benefit and general costs comparison were also seen. Different modellings were applied when performing the pharmacoeconomic analysis, such as Tree decision, Markov cohort, as well as methodologies like discrete event micro simulation and sequential simulation. Monte Carlo simulation was then used in five studies to analyze model sensitivity. The Linezolid treatment was shown to be more cost-effective than vancomycin in MRSA pneumonia. Doripinem also showed similar behavior when compared to imipinem in all included studies. Ceftazidime-avibactam and ceftalozane-tazobactam presented an advantage in cost-effectiveness when compared with meropenem. Clarithromycin and ceftriaxone+sulbactam+disodiumedetate used in adjuvant treatments, promoted reduction of the costs in patients with A. baumannii. Meropenem-varbobactam was also found to be a cost-effective treatment option when compared with standard therapies used in patients with CRE-KPC infections. Conclusion: Even though many models were used in pharmacoeconomic evaluations for VAP, Cost-effectiveness was clearly the most prevalent one. In short, the studies showed an advantage when using new medications. Nonetheless, we must be cautious when interpreting such findings, since they reflect a different reality for each country. Long-term impact and resource availability should also be considered.