Cost-effectiveness of ceftazidime/avibactam for infections due to carbapenem-resistant bacteria in Peru

Objectives: The objective of this study was to analyse the cost-effectiveness (C-E) of ceftazidime/avibactam (CAZ/AVI)-based therapy versus colistin (COL)-based therapy for pneumonia and bacteraemia caused by carbapenem-resistant enterobacteria (CRE) adjusted to Peruvian context. Methods: A Markov decision model was extrapolated from literature to evaluate the clinical and economic consequences of CAZ/AVI-based therapy compared to COL-based therapy for a hypothetical cohort of patients with CRE pneumonia or bacteraemia according to Peruvian context. It was adopted a 5-year time horizon and a Markov-cycle length of 1 year. All patients in the model were assigned to CRE pneumonia or bacteraemia state and may transit through four different health states: Home-care, long-term care without dialysis, long-term care with dialysis or death. Key findings: Intervention with CAZ/AVI becomes progressively more cost-effective from a threshold of S/24,000 or US$ 6666 (equivalent to 1 Gross Domestic Product-per cápita [GDP-pc]). The model simulation allowed to calculate an average total cost of S/2'971,582 (US$ 825,440) for CAZ/AVI against S/2'056,488 (US$ 571.247) for COL treatment, yielding an incremental cost of S/915,094 (US$ 254,193). The cost/QALY for CAZ/AVI treatment against COL therapy approaches to S/23,154 (US$ 6432), something less than 1 annual GDP-pc. There were additional benefits associated with CAZ/AVI in the 5-year horizon, such as: 21 deaths avoided, 86 hospital days avoided, 1 CRF5 avoided and a NMB of S/6649 (US$ 1847). Conclusions: The present transferability model demonstrates the C-E of CAZ/AVI over COL for the treatment of bacteraemia and CRE pneumonia according to peruvian payment thresholds.