Качественная клиническая практика (May 2018)
Comparative pharmacoeconomic analysis of ceffaroline fosamil in the treatment of complicated skin and soft tissues infections
Abstract
The objective was to evaluate the cost-effectiveness and budget impact of ceftaroline fosamil compared with other intravenous antibiotics with anti-MRSA activity in the treatment of complicated skin and soft tissue infections (cSSTI). The source of data on the efficacy and safety were randomized controlled trials and meta-analyzes devoted to the study of drugs for the treatment cSSTI. Comparison drugs were daptomycin, tigecycline, vancomycin and linezolid. To “overlap” gram-negative infections for vancomycin, linezolid and daptomycin was taken into account levofloxacin and cefoperazone/sulbactam with the share of each of them at 50%. For the efficacy was taken clinical response at day 7-14 after a course of treatment in ITT-population of patients with cSSTI. We calculated the direct medical and indirect non-medical costs associated with premature mortality. The data obtained are the following types of pharmacoeconomic analysis: cost-effectiveness analysis (CEA), budget impact analysis (BIA) and sensitivity analysis (SA). The results of pharmacoeconomic analyzes have shown that the cost-effectiveness ratio (CER) per patient was lowest in vancomycin - 79.613 rub., further follow: ceftaroline - 94.474 rub., linezolid - 118.049 rub., tigecycline - 122.424 rub. and daptomycin - 127.484 rub. Evaluation of cost-effectiveness threshold demonstrated that CER do not exceed the value of “willingness-to-pay ratio” none of the comparators, i.e., they are subject to state reimbursement under the compulsory health insurance system. Analysis of indirect costs per patient associated with premature mortality and the shortfall in GDP gave the following results: at ceftaroline they accounted for 31.391 rub., daptomycin - 78.458 rub., tigecycline - 105.688 rub., linezolid - 151.880 rub., vancomycin - 187.774 rub. The total costs (direct and indirect) per patient were at least in ceftaroline group - 108.094 rub., further follow: daptomycin - 182.102 rub., tigecycline - 203.493 rub., vancomycin - 251.743 rub. and linezolid - 252.151 rub. BIA shows that the transition from comparators to ceftaroline is costs saving overall of the budget: with linezolid - 144.056 rub., vancomycin - 143.649 rub., tigecycline - 95.399 rub., daptomycin - 74.008 rub. SA confirmed these results. Ceftaroline is the best alternative to daptomycin, tigecycline, vancomycin and linezolid. Active implementation of ceftaroline as a drug for the treatment of cSSTI can contribute both to optimize budget spending at various levels.
