Clinical Microbiology and Antimicrobial Chemotherapy. 2015; 17(1):33-51
Due to high activity against Streptococcus pneumoniae ceftaroline fosamil (CF) presents a good option for the treatment of adults with pneumococcal communityacquired pneumonia (PCAP) requiring parenteral antibacterial therapy. We aimed to assess cost-effectiveness of CF for the treatment of PCAP in a multi-field hospital in Russia from a societal perspective.
Decision tree model based on the results of two 3rd phase clinical trials (FOCUS 1, FOCUS 2) was created to represent a standard approach to the management of hospitalised patients with PCAP and estimated outcomes including possible recurrence of infection, direct and delayed attributive mortality in case of initial therapy with CF 600 mg BID vs. ceftriaxone (CS) 1 g / 2 g QD. Day 4 clinical response was taken for effectiveness outcome. Total expenses were estimated from societal perspective and comprised of direct medical (initial and alternative antibacterial therapy, PCAP recurrence treatment) as well as nonmedical direct (social benefits) and indirect ones (performance loss). Original drugs costs were extracted from wholesale prices database PHARMindex. Performance loss assessment was based on human capital approach (loss in gross domestic product per capita) with 5% discount rate per year. Uncertainty was explored in a series of one- and two-way deterministic and in probabilistic sensitivity analysis.
The respective total expenses of PCAP treatment with CF 600 mg BID vs. CS 1 g / 2 g QD were as follows: RUB 560 998.95 vs. RUB 572 719.08 / 575 361.86 which in view of higher effectiveness rates makes CF strategy the dominating one. In case of CS initial therapy effectiveness loss amounted to 17%, incremental costs — to RUB 11 720.13 / 14 362.91 with incremental cost-effectiveness ratios RUB 689.41 / 844.88 per 1% of lost effectiveness. The results were sensitive to change in rate of early clinical response to comparators (decrease to 66% / 65% for CF, increase to 62% / 63% for CS) and duration of CF course (increase to 11.2 / 11.8 days, respectively). Given the ceiling ratio RUB 435 95.1% / 97.3% of iterations in probabilistic sensitivity analysis recommended CF over CS 1 g / 2 g QD for the treatment of PCAP.
CF 600 mg BID is more cost effective then CS 1 g / 2 g QD in the treatment of hospitalised patients with PCAP from a societal perspective in Russia due to lesser total expenses and higher effectiveness rates associated with the strategy.