Cost effectiveness and resource allocation : C/E
Cost-effectiveness of empirical ceftazidime-avibactam for hospital-acquired urinary tract infections: a modeling study identifying key beneficiary subgroups
By Wu BS, Chang YY, Chen SC and 6 others.
Abstract
Background
Hospital-acquired urinary tract infections (HAUTIs) caused by Gram-negative bacilli are increasingly difficult to manage owing to rising carbapenem resistance. The novel antibiotic ceftazidime-avibactam (CAZ-AVI) is a potential alternative, but its cost-effectiveness in this setting is unknown. This study evaluated the cost-effectiveness of empirical CAZ-AVI versus a meropenem-first strategy for treating HAUTIs.
Methods
Using a patient-level decision-tree model, we simulated adult patients with HAUTIs in general ward and intensive care unit (ICU) settings in Taiwan, drawing on local pathogen distribution and antimicrobial susceptibility data. The model compared total costs and quality-adjusted life-years (QALYs); in the meropenem arm, pathogen-susceptible cases underwent antibiotic de-escalation once culture-guided susceptibility results were available. Clinical outcomes, utility weights, and costs were obtained from secondary sources of published studies, with all costs expressed in 2024 U.S. Dollars (USD) and future QALYs discounted at 3% annually. The primary outcome was the incremental cost-effectiveness ratio (ICER) per QALY gained, evaluated against a willingness-to-pay (WTP) threshold equal to Taiwan's 2024 GDP per capita ($33,983/QALY). Uncertainty was assessed with one-way, probabilistic, and scenario sensitivity analyses.