The cost-effectiveness of empirical antibiotic treatments for high-risk febrile neutropenic patients: A decision analytic model. Issue 20 (15th May 2020)

• Record Type: Journal Article
• Authors: Tori, Katerina; Tansarli, Giannoula S.; Parente, Diane M.; Kalligeros, Markos; Ziakas, Panayiotis D.; Mylonakis, Eleftherios
• Other Names: Snowden. Jessica section editor.
• Is Part Of: Medicine. Volume 99:Issue 20(2020)
• Publication Date: 2020-05-15
• Subjects: antipseudomonal beta-lactams -- cost-effectiveness -- empirical treatment -- febrile neutropenia -- hematological malignancies -- solid tumors; Medicine -- Periodicals; Medicine -- Periodicals; Médecine -- Périodiques; Geneeskunde; Medicine; Periodicals; Periodicals; 610.5
• DOI: 10.1097/MD.0000000000020022
• Languages: English
• ISSNs: 0025-7974

Abstract

Abstract: Purpose: Febrile neutropenia has a significant clinical and economic impact on cancer patients. This study evaluates the cost-effectiveness of different current empiric antibiotic treatments. Methods: A decision analytic model was constructed to compare the use of cefepime, meropenem, imipenem/cilastatin, and piperacillin/tazobactam for treatment of high-risk patients. The analysis was performed from the perspective of U.S.-based hospitals. The time horizon was defined to be a single febrile neutropenia episode. Cost-effectiveness was determined by calculating costs and deaths averted. Cost-effectiveness acceptability curves for various willingness-to-pay thresholds (WTP), were used to address the uncertainty in cost-effectiveness. Results: The base-case analysis results showed that treatments were equally effective but differed mainly in their cost. In increasing order: treatment with imipenem/cilastatin cost $52, 647, cefepime $57, 270, piperacillin/tazobactam $57, 277, and meropenem $63, 778. In the probabilistic analysis, mean costs were $52, 554 (CI: $52, 242-$52, 866) for imipenem/cilastatin, $57, 272 (CI: $56, 951-$57, 593) for cefepime, $57, 294 (CI: $56, 978-$57, 611) for piperacillin/tazobactam, and $63, 690 (CI: $63, 370-$64, 009) for meropenem. Furthermore, with a WTP set at $0 to $50, 000, imipenem/cilastatin was cost-effective in 66.2% to 66.3% of simulations compared to all other high-risk options. Discussion: Imipenem/cilastatin is a cost-effective strategy and results in considerable health care cost-savings at various WTP thresholds. Cost-effectiveness analyses can be used to differentiate the treatments of febrile neutropenia in high-risk patients. Abstract : Supplemental Digital Content is available in the text