Cost-effectiveness of ceftazidime/avibactam for infections due to carbapenem-resistant bacteria: analysis in Ecuadorian context

Abstract Aim To analyze the cost-effectiveness of ceftazidime/avibactam-based therapy (CAZ/AVI) versus colistin-based therapy (COL) for pneumonia/bacteremia caused by carbapenem-resistant enterobacterales adjusted to the Ecuador context. Methods A Markov decision model was extrapolated from literature. The analysis had a 5-year time horizon from the Ecuadorian Ministry of Health (MoH) perspective. The model is composed of five health states: (i) Pneumonia/bacteriemia, (ii) Home discharge (iii) Long-term care discharge (LTC), (iv) LTC with chronic dialysis, and (v) Death. The entire hypothetical cohort starts the Markov process in the pneumonia/bacteriemia state; then it can transit through the other health states according to transition probabilities. Patients who survive the acute infection state may develop nephrotoxicity, which could need renal replacement therapy for short- or long-term. Results The base case estimated for CAZ/AVI treatment an incremental cost-effectiveness ratio (ICER) of 10 273 USD per QALY gained, with an average incremental cost of USD 5489 and 0.5343 incremental QALYs for each patient during the 5-year time horizon. This deterministic ICER is equivalent to 1.5 the value of 1 GDP per capita in Ecuador. Conclusions CAZ/AVI showed a 92% probability of being cost-effective compared to treatment with COL, considering a maximum payment availability of USD 13 000 in the Ecuadorian context.