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Int J Antimicrob Agents. 2019 Jun 13. pii: S0924-8579(19)30161-X. doi: 10.1016/j.ijantimicag.2019.06.008. [Epub ahead of print]

Cost-effectiveness analysis of ceftazidime/avibactam compared to imipenem as empirical treatment for complicated urinary tract infections.

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Evidera, The Ark, 2nd Floor, 201 Talgarth Road, London, W6 8BJ, United Kingdom. Electronic address:
Justus-Liebig-University, Clinic of Urology, Pediatric Urology and Andrology, Rudolf-Buchheim-Str 7; D-35392, Giessen, Germany. Electronic address:
Department of Clinical and Experimental Medicine, University of Pisa, Lungarno Pacinotti 43, 56126, Pisa, Italy. Electronic address:
Evidera, Bég u. 3-5 / 520, 1022 Budapest, Hungary. Electronic address:
Pfizer, Via Valbondione, 113, 00188 Roma RM, Italy. Electronic address:
Pfizer, 23-25 Avenue du Dr Lannelongue, 75014, Paris, France. Electronic address:
Pfizer, 23-25 Avenue du Dr Lannelongue, 75014, Paris, France. Electronic address:


Ceftazidime/avibactam (CAZ-AVI) is a novel, fixed-dose combination antibiotic that has been approved in Europe and the United States for patients with complicated urinary tract infections (cUTIs), based on results of a Phase III, randomized, comparative study (RECAPTURE study). The present analysis evaluated cost-effectiveness of CAZ-AVI as an empiric treatment for hospitalized patients with cUTIs from the Italian publicly funded healthcare (third-party payer) perspective. A sequential, patient-level simulation model that followed the clinical course of cUTI and generated pairs of identical 5,000 patients (CAZ-AVI or imipenem as empiric treatment) was developed. The model included additional impact of resistant pathogens; patients who did not respond to empiric treatment were switched to second-line treatment of colistin+high dose carbapenem in both groups. The time horizon of the model was five years with an annual discount rate of 3% applied to both costs and quality-adjusted life-years (QALYs). The analysis demonstrated that intervention sequence (CAZ-AVI followed by colistin+high dose carbapenem) compared to comparator sequence (imipenem followed by colistin+high dose carbapenem) although at a net incremental cost of € 1,015 per patient, provided better health outcomes in terms of clinical cure (97.65% versus 91.08%; ∆=6.57%), shorter hospital stays (10.65 versus 12.55 days; ∆=1.90 days), and QALYs gained per patient (4.190 versus 4.063; ∆=0.126). The incremental cost-effectiveness ratio was € 8,039/QALY which is well below the willingness-to-pay threshold of € 30,000/QALY in Italy. The model results showed that CAZ-AVI is expected to be a cost-effective treatment compared to imipenem for cUTI in Italy.


CAZ-AVI (or ceftazidime/avibactam); Cost-effective analysis; Economic evaluation; RECAPTURE; Resistance; UTI (or urinary tract infection)

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