Pharmacoeconomic evaluation of the ceftolosan + tasobactam in the treatment of complicated nosocomial intraabdominal infections

Objective. To perform the pharmacoeconomic analysis of ceftolosan + tazobactam (Zerbaxa®) compared with the routine practice of antibacterial therapy of complicated intra-abdominal infections (clAI) and ceftazidime + avibactam (Zavicefta®).

Methods. The direct medical costs associated with antibacterial therapy of patients with clAI were calculated using the Markov model. The study horizon of cost-effectiveness analysis was 1 course of patient with clAI therapy and 3 years for the budget impact analysis. A comparative cost-effectiveness analysis was based on the monitoring program of antibiotic resistance, held in the Russian Institute of antimicrobial chemotherapy, the Interregional Association for clinical Microbiology and antimicrobial chemotherapy (AMRmap) and expected frequency sensitivity to ceftolosan + tazobactam, based on the prevalence of producers of metal- β -lactamase (hereinafter MBL) in Russia. The analyzing data considered the sensitivity of more than 40 thousand clinical isolates of microorganisms in 52 cities of the Russian Federation for 1997-2016 in the general population of patients. In the budget impact analysis was evaluated the economic impact of the market introduction of the ceftolosan + tazobactam (Zerbaxa®) compared with the current practice of antibiotic therapy of cIAI.

Results. Using ceftolosan + tazobactam as initial therapy in the general population of patients with cIAI, caused by P. aeruginosa, reduced direct medical costs of 1 completed case of cIAI treatment in comparison with the initial therapy of meropenem by 37 009 RUB (14,1 %), ceftazidime+avibactam — RUB 30 987 (12,1 %). Ceftolosan + tazobactam reduced the cost of life years gained (the coefficient of cost-effectiveness) in comparison with ceftazidime + avibactam by 16 %, meropenem — 28 %. Achieving over three years 12 % rate of the market ceftolosan + tazobactam will reduce the budget impact compared to current practice 291 511 151 RUB (average 1.3 %) for 3 years. This saving will further provide therapy ceftolosan + tazobactam 1296 people for 3 years. The administration ceftolosan + tazobactam leaded to increasing survival in patients with cIAI compared with cefepime — by 2.98 %, ceftazidime — 3.96 %, ceftazidime + avibactam — 1,79 %, meropenem — 7.71 %. The amount of life years gained in terms of 1,000 people increased in comparison with cefepime — on 699 years, ceftazidim — 931, ceftazidime+avibactam — 421, meropenem — 1811. The cost of the empirical drug course (3 days) without sensitivity was: 55 432 RUB for ceftolosan + tazobactam, which is cheaper than therapy ceftazidime+avibactam for 17 801 RUB, and more expensive for 41 563 RUB, 48 444 and 52 775 RUB compared to empirical therapy with meropenem, cefepime and ceftazidime respectively.

Conclusion. Ceftolosan + tazobactam (Zerbaxa®) in the treatment of cIAI caused by P. aeruginosa, is dominant option in comparison with the drugs used in routine practice in the treatment of cIAI in Russia and the drug of a new class of inhibitors of β -lactam/β -lactamase — ceftazidime+avibactam, due to higher efficiency and lower associated direct medical costs.

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