Economic analysis of ceftaroline fosamil for treating community-acquired pneumonia in Spain

Figures & data

Figure 1. Schematic visualization of the decision-tree model. Over each branch, a brief description of the corresponding patient pathway has been summarized. Abbreviations. CAP, community-acquired pneumonia; ICU, intensive care unit; IV, intravenous.

Table 1. Clinical inputs for the cost-effectiveness analysis.

Description	Base-case	SE	Distribution	Source
Probability of clinical cure with CFT Probability of clinical cure with CFT in pneumococcal pneumonia	0.843 0.855	0.0170 0.042	Beta Beta	^16
Relative risk clinical cure CFT vs. ceftriaxone Probability of clinical cure with ceftriaxone in pneumococcal pneumonia	1.10 0.686	0.028 0.052	LogNormal Beta	^16 ^25
Relative risk clinical cure CFT vs. co-amoxiclav	1.18	0.05	LogNormal	^25
Relative risk clinical cure CFT vs. levofloxacin	1.05	0.05	LogNormal	^25
Relative risk clinical cure CFT vs. moxifloxacin	1.08	0.04	LogNormal	^25
Probability of Day 4 clinical response for CFT	0.695	0.0371	Beta	^17
Probability of Day 4 clinical response for CFT in pneumococcal pneumonia	0.73	0.0516	Beta	^17
Probability of Day 4 clinical response for ceftriaxone	0.594	0.0394	Beta	^17
Probability of Day 4 clinical response for ceftriaxone in pneumococcal pneumonia	0.56	0.0567	Beta	^17
Probability of Day 4 clinical response for co-amoxiclav	NA	NA	NA
Probability of Day 4 clinical response for moxifloxacin	NA	NA	NA
Probability of Day 4 clinical response for levofloxacin	0.34	0.046	Beta	^26

Abbreviations. CFT, ceftaroline fosamil; NA, not applicable; SE, standard error.

Table 2. Economic inputs for the cost-consequences analysis.

Health care resource use	Average value (SE)	Distribution	Reference
Mean hospital LOS (95% CI) initial antibiotic treatment success (days)	11.3 (0.24)	Normal	^23
Mean hospital LOS (95% CI) initial antibiotic treatment failure (days)	15.3 (0.5)	Normal	^23
Proportion of treatment failures admitted to ICU	19.8% (1.57%)	Beta	^23
Duration of ICU stay (days)	10.9 (0.51)	Normal	^23
Proportion of patients eligible for IV-to-oral therapy	44% (3.51%)	Beta	^22
Duration of antibiotic treatment (days)	6.6	1	^16
Duration of second-line antibiotic treatment (days)	7	1	Assumption
Unit costs	Value (€ 2017)	Reference
Hospital day stay (per day)	553.90	Spanish National Price List^30
ICU stay (per day)	1,456.52
Drug Acquisition Costs (per unit/per day)
Ceftaroline 600 mg q12hr	60.00/120.00
Ceftriaxone 1 g q24hr	3.89/3.89
Co-amoxiclav 1.2 g q8hr	4.0/12.0
Moxifloxacin 400 mg q24hr	31.2/31.2
Levofloxacin 500 mg q24hr	12.15/12.15
Oral Step-down Antibiotic (co-amoxiclav)	4.0/12.0
Second-line antibiotic in general ward (ceftriaxone)	3.89/3.89
Second-line antibiotic in ICU (ceftriaxone + azithromycin)	10.86/10.86

Abbreviations. CI, confidence interval; ICU, intensive care unit; IV, intravenous; LOS, length of stay; q8hr, every eight hours; q12hr, every 12 hours; q24hr, every 24 hours; SE, standard error.

Figure 2. Comparison of total costs per patient (left side) and the percentage of patients discharged early (right side) for CFT, Ceftriaxone, and Levofloxacin. Abbreviations. CFT, ceftaroline fosamil; q12hr, every 12 hours; q24hr, every 24 hours

Table 3. Total and incremental percentage of patients, for each treatment pathway (according to Figure 1), predicted by the model.

	All pneumonias					Pneumococcal pneumonia
	CFT	Ceftriaxone		Levofloxacin		CFT	Ceftriaxone
	Total (%)	Total (%)	Incremental vs. CFT (%)	Total	Incremental vs. CFT	Total (%)	Total (%)	Incremental vs. CFT (%)
Initial antibiotic treatment success. Patient remains on initial antibiotic to complete IV course of therapy. (Pathway A + Pathway C)	64.63	64.38	0.25	72.03	7.4%	63.97	61.54	2.43
Initial antibiotic treatment success. Clinical response achieved at Day 4. Patients switched to oral antibiotic and discharged early (Pathway B)	30.58	26.14	4.44	14.96	15.62%	32.12	24.64	7.48
Initial antibiotic treatment failure. Patients switched to second-line antibiotic and managed in general ward (Pathway D)	3.84	7.61	−3.77	10.44	−6.6%	3.14	11.08	−7.94
Initial antibiotic treatment failure. Patients switched to second-line antibiotic and managed in ICU (Pathway E)	0.95	1.88	−0.93	2.58	−1.63	0.78	2.74	−1.96

Abbreviations. CFT, ceftaroline fosamil; ICU, intensive care unit; IV, intravenous.

Table 4. Total and incremental hospital costs per patient by antibiotic regimen and pneumonia type.

	All Pneumonias (€ 2017)					Pneumococcal pneumonia (€ 2017)
	CFT	Ceftriaxone		Levofloxacin		CFT	Ceftriaxone
	Total	Total	Incremental vs. CFT	Total	Incremental vs. CFT	Total	Total	Incremental vs. CFT
Total average hospital cost	€5,929.59	€5,643.49	€286.10	€6,283.92	€−354.33	€5,829.77	€5,884.40	€−54.63
Initial antibiotic therapy	€681.65	€22.07	€659.58	€71.36	€610.29	€679.57	€21.78	€657.79
Oral antibiotic step-down	€24.22	€20.70	€3.52	€11.85	€12.37	€25.44	€19.51	€5.92
Second-line antibiotic	€1.77	€3.50	€−1.73	€4.80	€−3.03	€1.44	€5.10	€−3.65
Hospital stay (general ward)	€5,071.43	€5,299.04	€−227.61	€5,786.91	€−715.48	€5,000.25	€5,403.71	€−403.46
Hospital stay (ICU)	€150.52	€298.18	€−147.65	€409.01	€−258.48	€123.07	€434.30	€−311.23

Abbreviations. CFT, ceftaroline fosamil; ICU, intensive care unit.

Figure 3. Deterministic sensitivity analysis results: CFT 600 mg q12hr versus Ceftriaxone 1 g q24hr (a); CFT 600 mg q12hr versus Levofloxacin 500 mg q24hr (b). Abbreviations. ABT, antibiotic therapy; CFT, ceftaroline fosamil; LOS, length of stay; q12hr, every 12 hours; q24hr, every 24 hours.

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