Economic Evaluation of Cefiderocol for the Treatment of Carbapenem- Resistant Infections in Italy

Abstract Background Antimicrobial resistance (AMR) has become an increasing concern to healthcare systems worldwide and is currently recognised as a major urgent threat to public health. In 2017, the World Health Organisation (WHO) specifically highlighted the threat of gram-negative bacteria resistant to multiple antibiotics, specifying three ‘Priority 1 – Critical’, carbapenem-resistant (CR) pathogens for which drugs are urgently required to address. Cefiderocol, a parenteral antibiotic, is the first antibiotic to address all three priority 1 pathogens described by the WHO. Methods A decision-tree model was built to determine the cost-effectiveness of cefiderocol vs colistin and colistin based regimens, for the treatment of seriously ill patients with a confirmed CR infection in Italy. A scenario analysis was also run comparing the cost-effectiveness of cefiderocol with ceftazidime/avibactam for the treatment of seriously ill patients with a suspected CR infection. The evaluation was performed from a health care perspective with a lifetime time horizon. Deterministic and probabilistic sensitivity analyses were also conducted to account for uncertainty. Results Cefiderocol was shown to be cost-effective when compared with colistin and colistin based regimens in the confirmed CR population at a cost-effectiveness threshold of €40,000, with an incremental cost-effectiveness ratio of €11,430 and incremental net monetary benefit of €18,751. The probabilistic sensitivity analysis results in a probability of cost-effectiveness of 70.1% and the probability of a sustained cure was the main driver of the economic model. Cefiderocol was also cost-effective in the suspected CR population. Conclusions Cefiderocol is cost-effective from the Italian health care perspective when used to treat seriously ill patients with both confirmed, and suspected, CR infections.