A Cost-Effectiveness Analysis Comparing Ceftazidime-Avibactam with Meropenem for the Treatment of Hospital-Acquired Pneumonia (Including Ventilator-Associated Pneumonia)

Objective: To evaluate the cost-effectiveness of ceftazidime-avibactam(CAZ-AVI) compared with meropenem for the treatment of hospital-acquired pneumonia (HAP)/ventilator-associated pneumonia (VAP). Methods: A decision tree model was constructed based on real-world antibiotic resistance data in China to compare the clinical efficacy, survival outcomes, and medical costs of CAZ-AVI versus meropenem for HAP/VAP treatment. Model inputs were derived from literature and local databases. Deterministic and sensitivity analyses were performed. Results: Base-case analysis showed the ICER of CAZ-AVI was $35,328.2 per QALY gained, slightly below China’s 2022 willingness-to-pay (WTP) threshold of 3 times per capita GDP ($36,598 per QALY). Without considering antibiotic resistance, CAZ-AVI was inferior to meropenem in both effectiveness and costs. The high price of CAZ-AVI significantly affected its cost-effectiveness. Probabilistic sensitivity analysis indicated that CAZ-AVI had an approximately 75% probability of being optimal only when the WTP reached $44,400 per QALY. Conclusion: Although current cost-effectiveness of CAZ-AVI for HAP/VAP was unfavorable, its use may be considered in settings with higher rates of antibiotic resistance. Price reduction would also enhance its advantage. Judicious antibiotic stewardship and resistance surveillance remain vital as well.