Economic assessment of doripenem versus imipenem in the treatment of ventilator-associated pneumonia

Abstract

Background: Ventilator-associated pneumonia (VAP), the most common nosocomial infection in critically ill patients, is associated with significantly longer duration of mechanical ventilation, and increased mortality, hospital days, and health-care costs. A previously published prospective, randomized study established the noninferiority of intravenous (IV) doripenem versus IV imipenem/cilastatin (‘imipenem‘) for VAP. This study compares the economic outcomes of IV therapy with doripenem versus imipenem as first-line treatment for VAP.

Methods: A decision-analytic model of inpatient care and outcomes for VAP was used to estimate costs associated with VAP treatment. The model calculates total hospital costs, comprising costs of initial and concomitant therapy, and costs associated with mechanical ventilation, intensive care unit stays, and total days in hospital.

Results: Total treatment costs for doripenem were $10,630 lower than for imipenem ($71,259 vs. 81,889), driven primarily by differences in costs of mechanical ventilation ($45,224 for doripenem, $57,348 for imipenem). Probabilistic sensitivity analyses found doripenem consistently cost saving versus imipenem in 1,000 simulations. Study limitations include use of a simple model to represent a complex disease process and reliance on trial data that may not reflect real-world care and outcomes.

Conclusions: Doripenem is a cost saving first-line treatment for VAP versus imipenem while providing an equivalent rate of cure.

Key words::

• cost effectiveness
• doripenem
• economic model
• imipenem
• ventilator-associated pneumonia

Transparency

Declaration of funding: This study was funded by Johnson & Johnson Pharmaceutical Services, LLC.

Declaration of financial/other relationships: L.J.M., V.P., K.D., D.T., and M.C.W. have disclosed that they are paid consultants of Johnson & Johnson. S.M., K.A. and M.I. have disclosed that they are employees of Johnson & Johnson. D.P. has disclosed that he has received honoraria for serving on Johnson & Johnson's Advisory Board in the past, but has received no honoraria for this study.

The JME peer reviewers 1 and 2 have not received an honorarium for their review work on this manuscript. Both have disclosed that they have no relevant financial relationships.

Acknowledgements: The authors would like to acknowledge the assistance of Victoria Porter, i3 Innovus, for her help with editorial and manuscript preparation; and Chris Gast, Johnson & Johnson, for his help with statistical analysis.

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