Cost-effectiveness analysis of Vaborem in Carbapenem-resistant Enterobacterales (CRE) -Klebsiella pneumoniae infections in Italy

Abstract

Background Vaborem is a fixed dose combination of vaborbactam and meropenem with potent activity against target Carbapenem-resistant Enterobacterales (CRE) pathogens, optimally developed for Klebsiella pneumoniae carbapenemase (KPC). The study aims to evaluate the cost-effectiveness of Vaborem versus best available therapy (BAT) for the treatment of patients with CRE-KPC associated infections in the Italian setting. Methods A cost-effectiveness analysis was conducted based on a decision tree model that simulates the clinical pathway followed by physicians treating patients with a confirmed CRE-KPC infection in a 5-year time horizon. The Italian National Health System perspective was adopted with a 3% discount rate. The clinical inputs were mostly sourced from the phase 3, randomised, clinical trial (TANGO II). Unit costs were retrieved from the Italian official drug pricing list and legislation, while patient resource use was validated by a national expert. Model outcomes included life years (LYs) and quality adjusted life years (QALYs) gained, incremental costs, incremental cost-effectiveness ratio (ICER) and incremental cost-utility ratio (ICUR). Deterministic and probabilistic sensitivity analyses were also performed. Results Vaborem is expected to decrease the burden associated with treatment failure and reduce the need for chronic renal replacement therapy while costs related to drug acquisition and long-term care (due to higher survival) may increase. Treatment with Vaborem versus BAT leads to a gain of 0.475 LYs, 0.384 QALYs, and incremental costs of €3549, resulting in an ICER and ICUR of €7473/LY and €9246/QALY, respectively. Sensitivity analyses proved the robustness of the model and also revealed that the probability of Vaborem being cost-effective reaches 90% when willingness to pay is €15,850/QALY. Conclusions In the Italian setting, the introduction of Vaborem will lead to a substantial increase in the quality of life together with a minimal cost impact, therefore Vaborem is expected to be a cost-effective strategy compared to BAT.

Costs-effectiveness and cost components of pharmaceutical and non-pharmaceutical interventions affecting antibiotic resistance outcomes in hospital patients: a systematic literature review

“… 51 Additionally, treating patients with complicated intra-abdominal infections following ceftolozane/tazobactam+metronidazole was found to be cost-effective (ICER=$8551 per QALY gained), compared with piperacillin/tazobactam. 52 Mennini et al 53 and Vlachaki et al 54 assessed meropenem-vaborbactam versus the best available treatment for CRE patients, revealing ICERs of $11 813 and $20 486 per QALY, respectively. The disparity arises from three times higher drug costs for meropenem-vaborbactam compared with the best available therapy in the UK, 54 while in the Italy-based study, 53 it was only 1.5 times higher.…”

“… 52 Mennini et al 53 and Vlachaki et al 54 assessed meropenem-vaborbactam versus the best available treatment for CRE patients, revealing ICERs of $11 813 and $20 486 per QALY, respectively. The disparity arises from three times higher drug costs for meropenem-vaborbactam compared with the best available therapy in the UK, 54 while in the Italy-based study, 53 it was only 1.5 times higher. Furthermore, the UK-based study attributed higher costs to long-term care tariffs associated with increased survivability among meropenem-vaborbactam.…”

Cost-effectiveness analysis of ceftazidime-avibactam as definitive treatment for treatment of carbapenem-resistant Klebsiella pneumoniae bloodstream infection

“…After hospitalization, patients may be discharged to home, discharged to a long-term care facility or chronic dialysis and entered into the 5-year Markov model linked to the decision tree model. Due to the lack of data, a 5year Markov model was considered to estimate differences among therapy regimens in terms of costs and effectiveness and in line with other published economic studies (18,(20)(21)(22). Four states were presented in the Markov model including: 1. home; 2. long-term care facility; 3. chronic dialysis; 4. death.…”