Cost-effectiveness analysis comparing ceftazidime/avibactam (CAZ-AVI) as empirical treatment comparing to ceftolozane/tazobactam and to meropenem for complicated intra-abdominal infection (cIAI)

Antimicrob Resist Infect Control. 2019 Dec 21;8:204. doi: 10.1186/s13756-019-0652-x. eCollection 2019.


Background: The rising incidence of resistance to currently available antibiotics among pathogens, particularly Gram-negative pathogens, in complicated intra-abdominal infections (cIAIs) has become a challenge for clinicians. Ceftazidime/avibactam (CAZ-AVI) is a fixed-dose antibiotic approved in Europe and the United States for treating (in combination with metronidazole) cIAI in adult hospitalised patients who have limited or no alternative treatment options. The approval was based on the results of RECLAIM, a Phase III, parallel-group, comparative study (RECLAIM 1 [NCT01499290] and RECLAIM 2 [NCT01500239]). The objective of our study was to assess the cost-effectiveness of CAZ-AVI plus metronidazole compared with 1) ceftolozane/tazobactam plus metronidazole and 2) meropenem, as an empiric treatment for the management of cIAI in Italy.

Methods: A sequential, patient-level simulation model, with a 5-year time horizon and 3% annual discount rate (applied to both costs and health benefits), was developed using Microsoft Excel® to demonstrate the clinical course of the disease. The impact of resistant pathogens was included as an additional factor.

Results: In the base-case analysis, the CAZ-AVI sequence (CAZ-AVI plus metronidazole followed by a colistin + tigecycline + high-dose meropenem combination after treatment failure), when compared to sequences for ceftolozane/tazobactam (ceftolozane/tazobactam plus metronidazole followed by colistin + tigecycline + high-dose meropenem after treatment failure) and meropenem (meropenem followed by colistin + tigecycline + high-dose meropenem after treatment failure), had better clinical outcomes with higher cure rates (93.04% vs. 91.52%; 92.98% vs. 90.24%, respectively), shorter hospital stays (∆ = - 0.38 and ∆ = - 1.24 days per patient, respectively), and higher quality-adjusted life years (QALYs) gained per patient (4.021 vs. 3.982; 4.019 vs. 3.960, respectively). The incremental cost effectiveness ratio in the CAZ-AVI sequence was €4099 and €15,574 per QALY gained versus each comparator sequence, respectively, well below the willingness-to-pay threshold of €30,000 per QALY accepted in Italy.

Conclusions: The model results demonstrated that CAZ-AVI plus metronidazole could be a cost-effective alternative when compared with other antibiotic treatment options, as it is expected to provide better clinical benefits in hospitalised patients with cIAI in Italy.

Keywords: Ceftazidime-avibactam plus metronidazole; Ceftolozane/tazobactam plus metronidazole; Complicated intra-abdominal infection; Cost-effectiveness analysis; Economic model; Meropenem.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Anti-Bacterial Agents / economics
  • Anti-Bacterial Agents / therapeutic use*
  • Azabicyclo Compounds / economics
  • Azabicyclo Compounds / therapeutic use*
  • Bacterial Infections / complications
  • Bacterial Infections / drug therapy
  • Bacterial Infections / economics
  • Ceftazidime / economics
  • Ceftazidime / therapeutic use*
  • Cephalosporins / economics
  • Cephalosporins / therapeutic use*
  • Cost-Benefit Analysis*
  • Drug Combinations
  • Hospitalization / economics
  • Humans
  • Intraabdominal Infections / drug therapy*
  • Intraabdominal Infections / economics
  • Intraabdominal Infections / microbiology
  • Italy
  • Meropenem / economics
  • Meropenem / therapeutic use*
  • Models, Economic
  • Tazobactam / economics
  • Tazobactam / therapeutic use*


  • Anti-Bacterial Agents
  • Azabicyclo Compounds
  • Cephalosporins
  • Drug Combinations
  • avibactam, ceftazidime drug combination
  • ceftolozane, tazobactam drug combination
  • Ceftazidime
  • Meropenem
  • Tazobactam

Associated data