The Cost-Effectiveness of Cefepime plus Metronidazole versus Imipenem/Cilastatin in the Treatment of Complicated Intra-Abdominal Infection

Barie, Philip S.; Rotstein, Ori D.; Dellinger, E. Patchen; Grasela, Thaddeus H.; Walawander, Cynthia A.

doi:10.1089/sur.2004.5.269

Cited by 9 publications

(4 citation statements)

References 36 publications

(37 reference statements)

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“…However, according to the spectrum and the place that C/T will occupy in the therapeutic arsenal for the treatment of cUTI, the evaluated alternatives can be considered reasonable comparators. Likewise, some studies use clinical healing rates directly derived from clinical trials as efficacy measure, which can result in different conclusions for one same comparison [18][19][20] .…”

Section: Discussionmentioning

confidence: 99%

Cost-effectiveness of ceftolozane/tazobactam for the treatment of complicated intraabdominal and urinary tract infections in Colombia

Hernández

Lasalvia

Garzón

et al. 2020

Infect

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Objective: To evaluate the cost-effectiveness of ceftolozane/tazobactam + metronidazole (C/T+M) and ceftolozane/tazobactam (C/T) compared with 8 alternatives used in the treatment of complicated intraabdominal infection (cIAI) and complicated urinary tract infection (cUTI) respectively. Methods: A Monte Carlo simulation decision model was used for the estimation and comparison of treatment-related costs, and quality adjusted life years for patients with cIAI treated with C/T+M in comparison with cefepime + metronidazole, ciprofloxacin + metronidazole, doripenem, levofloxacin + metronidazole, meropenem, piperacillin/tazobactam, ceftazidime + metronidazole or imipenem/cilastatin and patients with cUTI treated with C/T in comparison with cefepime, ciprofloxacin, doripenem, levofloxacin, meropenem, piperacillin/tazobactam, ceftazidime or imipenem/cilastatin. Local costs were estimated using base cases identified by experts and consulting local databases. Sensitivity values of the PACTS (Program to Assess Ceftolozane/Tazobactam Susceptibility) study in Latin America were used in the model. Results: C/T+M and C/T obtained incremental cost-effectiveness ratios (ICER) that were below the Colombian cost-effectiveness threshold (3 GDP per capita) in most comparisons, and were dominated by meropenem, considering only gram-negative microorganisms. Sensitivity assessments were also carried out, in which only the population with P. aeruginosa infections was considered, showing positive results for C/T+M and C/T (cost-effective or dominant with regards to all comparators). Conclusions: C/T+M and C/T could be cost-effective alternatives in the treatment of CIAI and CUTI in Colombia, when there is an adequate and rational use of antibiotics. The results of the sensitivity analyses showed dominance and cost-effectiveness with regards to every comparator in patients infected with P. aeruginosa

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Section: Discussionmentioning

confidence: 99%

Cost-effectiveness of ceftolozane/tazobactam for the treatment of complicated intraabdominal and urinary tract infections in Colombia

Hernández

Lasalvia

Garzón

et al. 2020

Infect

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“…A patient-level simulation model published by Prabhu et al in 2017 demonstrated that ceftolozane/tazobactam plus metronidazole was more cost effective and dominated piperacillin-tazobactam as an empiric treatment, due to lower total cost per patient ($ 44,226 vs. $ 44,811 respectively) and higher QALYs gained per patient (12.85 vs. 12.70), resulting in reduced length of hospital stay (∆ = 0.63 days) per patient [5]. In an earlier study, Barie et al compared the economic benefits of cefepime plus metronidazole with those of imipenem-cilastatin in the treatment of cIAIs; that study showed the cost effectiveness of cefepime [39].…”

Section: Discussionmentioning

confidence: 99%

Cost-effectiveness analysis comparing ceftazidime/avibactam (CAZ-AVI) as empirical treatment comparing to ceftolozane/tazobactam and to meropenem for complicated intra-abdominal infection (cIAI)

Kongnakorn¹,

Eckmann²,

Bassetti³

et al. 2019

Antimicrob Resist Infect Control

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BackgroundThe rising incidence of resistance to currently available antibiotics among pathogens, particularly Gram-negative pathogens, in complicated intra-abdominal infections (cIAIs) has become a challenge for clinicians. Ceftazidime/avibactam (CAZ-AVI) is a fixed-dose antibiotic approved in Europe and the United States for treating (in combination with metronidazole) cIAI in adult hospitalised patients who have limited or no alternative treatment options. The approval was based on the results of RECLAIM, a Phase III, parallel-group, comparative study (RECLAIM 1 [NCT01499290] and RECLAIM 2 [NCT01500239]). The objective of our study was to assess the cost-effectiveness of CAZ-AVI plus metronidazole compared with 1) ceftolozane/tazobactam plus metronidazole and 2) meropenem, as an empiric treatment for the management of cIAI in Italy.MethodsA sequential, patient-level simulation model, with a 5-year time horizon and 3% annual discount rate (applied to both costs and health benefits), was developed using Microsoft Excel® to demonstrate the clinical course of the disease. The impact of resistant pathogens was included as an additional factor.ResultsIn the base-case analysis, the CAZ-AVI sequence (CAZ-AVI plus metronidazole followed by a colistin + tigecycline + high-dose meropenem combination after treatment failure), when compared to sequences for ceftolozane/tazobactam (ceftolozane/tazobactam plus metronidazole followed by colistin + tigecycline + high-dose meropenem after treatment failure) and meropenem (meropenem followed by colistin + tigecycline + high-dose meropenem after treatment failure), had better clinical outcomes with higher cure rates (93.04% vs. 91.52%; 92.98% vs. 90.24%, respectively), shorter hospital stays (∆ = − 0.38 and ∆ = − 1.24 days per patient, respectively), and higher quality-adjusted life years (QALYs) gained per patient (4.021 vs. 3.982; 4.019 vs. 3.960, respectively). The incremental cost effectiveness ratio in the CAZ-AVI sequence was €4099 and €15,574 per QALY gained versus each comparator sequence, respectively, well below the willingness-to-pay threshold of €30,000 per QALY accepted in Italy.ConclusionsThe model results demonstrated that CAZ-AVI plus metronidazole could be a cost-effective alternative when compared with other antibiotic treatment options, as it is expected to provide better clinical benefits in hospitalised patients with cIAI in Italy.

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“…The AMMI Canada guidelines on nosocomial pneumonia have shown that metronidazole has excellent activity against anaerobic bacteria, antibiotic breakpoints from the National Committee for Clinical Laboratory Standards approved and tentative breakpoints. 10 It was also used in the therapy of px 27 and px36 peritonitis patients, and as well as becomes one of the treatment options in the management of peritonitis infection. A combination of antibiotic therapy with micafungin in px05 and px25 patients was used to treat fungal infections.…”

Section: Disscussionmentioning

confidence: 99%

Evaluation of empirical antibiotic usage and cost analysis of patients with nosocomial pneumonia in ICU of RSUP Dr. Sardjito, yogyakarta

Manik

Asdie

Puspitasari

2020

IJPTher

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The rationality of antibiotic usage has an implication on the therapeutic quality and antimicrobial resistance control. Qualitative and quantitative evaluation of this rationality becomes one quality indicator of hospitals' antimicrobial resistance programs. Therefore, this study aims to determine the relationship between the rationality of antibiotic usage with clinical outcomes and the total cost in nosocomial pneumonia patients treated in the Intensive Care Unit (ICU). The method used was descriptive-analytic observational research with a cross-sectional design analysis, and data were collected retrospectively from the medical and financial record of patients with inclusion criteria. The data were then analyzed descriptively using the Gyssens flowchart. Fisher statistical test was conducted to analyze the relationship between rationality data and therapeutic outcomes. Furthermore, the Mann Whitney statistical test was conducted to examine the relationship between rationality data and the cost, while the paired t-test was conducted to analyze the resistance pattern. The results showed that antibiotic usage in patients with nosocomial pneumonia at the ICU of RSUP Dr. Sardjito was irrational and rational by 30.21% (29 regimens) and 69.79% (67 regimens) respectively. This rationality has a relation with clinical outcome based on Fisher test with p-value = 0.001 (p <0.05). Considering these results, the antibiotics cost both in the rational and irrational category has no significant difference with the p-value of 0.90 (p<0.05).

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The Cost-Effectiveness of Cefepime plus Metronidazole versus Imipenem/Cilastatin in the Treatment of Complicated Intra-Abdominal Infection

Cited by 9 publications

References 36 publications

Cost-effectiveness of ceftolozane/tazobactam for the treatment of complicated intraabdominal and urinary tract infections in Colombia

Cost-effectiveness of ceftolozane/tazobactam for the treatment of complicated intraabdominal and urinary tract infections in Colombia

Cost-effectiveness analysis comparing ceftazidime/avibactam (CAZ-AVI) as empirical treatment comparing to ceftolozane/tazobactam and to meropenem for complicated intra-abdominal infection (cIAI)

Evaluation of empirical antibiotic usage and cost analysis of patients with nosocomial pneumonia in ICU of RSUP Dr. Sardjito, yogyakarta

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