Clinical Efficacy and Cost-Effectiveness of β-Lactam/β-Lactamase Inhibitor Combinations and Carbapenems in Liver Cirrhosis Patients with Gram-Negative Bacteria Bloodstream Infection

Abstract

Yuzhu Dong,1,* Ying Li,2,* Ying Zhang,1 Dan Sun,1 Qian Du,1 Tao Zhang,1 Mengmeng Teng,1 Ruiying Han,1 Yan Wang,3 Li Zhu,4 Jin’e Lei,5 Yalin Dong,1 Taotao Wang1 1Department of Pharmacy, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, People’s Republic of China; 2Department of Pharmacy, Xi’an NO.3 Hospital, Xi’an 710082, People’s Republic of China; 3Department of Pharmacy, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, People’s Republic of China; 4Department of Infections, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, People’s Republic of China; 5Department of Laboratory, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, People’s Republic of China*These authors contributed equally to this workCorrespondence: Yalin DongDepartment of Pharmacy, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, People’s Republic of ChinaTel/Fax [phone]Email [email protected] WangDepartment of Pharmacy, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, People’s Republic of ChinaTel/Fax [phone]Email [email protected]: Gram-negative bacteria bloodstream infection (GNB-BSI) results in considerable mortality and hospitality costs in cirrhotic patients. β-lactam/β-lactamase inhibitor combinations (BLBLIs) and carbapenems (CARs) are widely recommended for treating GNB-BSI in cirrhotic patients, while the efficacy and cost-effectiveness of two strategies have never been evaluated. Therefore, we conducted a retrospective cohort study to evaluate the efficacy and the cost-effectiveness of BLBLIs and CARs.Patients and Methods: Cirrhotic patients with GNB-BSI treated by BLBLIs or CARs were included. A propensity score-matching analysis was performed to compare the efficacy between BLBLIs and CARs. A decision tree was used to estimate the clinical outcomes and direct costs of treating BSI using two strategies from the patients’ perspective.Results: No statistically significant difference was found between the BLBLIs (n = 41) group and the CARs (n = 43) group regarding the time to defervescence (2.4 ± 0.2 vs 2.5 ± 0.3, P = 0.94). Thirty-seven patients from each group were matched in propensity-score-matched cohort, and there was no significant difference between two groups in terms of the time to defervescence (2.4 ± 0.3 vs 2.4 ± 0.3, P = 0.75) and success rate (86.5% vs 78.4%; OR = 0.57; P = 0.36). Based on the drug and hospital costs in China, cefoperazone/sulbactam was cost-effective in the present analysis under the willingness-to-pay threshold (¥ 64,644).Conclusion: The efficacy of BLBLIs is similar to CARs. Cefoperazone/sulbactam could be a cost-effective therapy in cirrhotic patients with GNB-BSI. Carbapenems-sparing regimens should be encouraged in regions with a low prevalence of MDR bacteria.Keywords: liver cirrhosis, gram-negative bacteria, bloodstream infection, efficacy, cost-effectiveness

Keywords

• liver cirrhosis
• gram-negative bacteria
• bloodstream infection
• efficacy
• cost-effectiveness;