Inpharma 1608 - 6 Oct 2007

Pharmacoeconomic news from ICAACChicago, Illinois, US September 2007

At the 47th Interscience Conference on Antimicrobial where resistance rates were higher, cost savings perAgents and Chemotherapy (ICAAC), failure avoided were highest; conversely, in Belgium andpharmacoeconomic and outcomes research on the Germany cost savings per failure avoided were lowest.following agents was presented: Telavancin value vanquishes vancomycin• moxifloxacin for community-acquired pneumonia Telavancin,* a novel lipoglycopeptide antibacterial, is(CAP) cost effective over vancomycin for CSSSIs, particularly• telavancin and vancomycin for complicated skin and those caused by meticillin-resistant Staphylococcusskin structure infections (CSSSIs) aureus (MRSA), say investigators from the US.2• anidulafungin and fluconazole for candidaemia They used outcomes and treatment data from the• antibacterials for postinfluenza bacterial CAP. ATLAS** studies, and costs† data from a single hospital’s

Moxifloxacin makes a difference for CAP 2006 billing database in their research; analyses wereA multinational group of researchers has found that conducted for 1051 clinically evaluable patients

moxifloxacin is cost effective for the first-line treatment of (518 telavancin recipients), of whom 339 had MRSACAP, compared with macrolides and β-lactams, (160 telavancin recipients).‡

regardless of antimicrobial resistance.1 Cure rates were similar for telavancin andUsing a decision analytic model, they calculated the vancomycin, overall (86.1% vs 85.0%, respectively), and

incremental cost-effectiveness ratios (ICERs) of in the MRSA cohort (87.5% vs 83.2%, respectively).empirical antibacterial treatments for CAP in France, Similarly, total infection-related costs were similar forBelgium, the US and Germany, from a third-party payer telavancin and vancomycin, overall, and in the MRSAperspective; the model incorporated resistance rates for cases($US5957 vs $US5957 and $US5957 vs $US6350,Streptococcus pneumoniae and Haemophilus respectively).influenzae. Costs were inflated to 2006 levels in the local In the MRSA population, telavancin held to the samecurrency, and included GP, specialist and emergency price as vancomycin dominated vancomycin, with adepartment consultations, chest x-rays, white blood cell base case ICER of $US–3029. Sensitivity analyses withcounts, and hospitalisation costs; in general, drug costs the daily cost of telavancin increased to $US25, $US50for 10-day treatments were included. and $US100 more than vancomycin, the ICERs were

First-line treatment with moxifloxacin dominated $US2021, $US7072 and $US17 174, respectively.treatment with a macrolide or β-lactam in each country Anidulafungin cost-effective for candidaemia[see table]. After conducting the first-cost-effective analysis of

anidulafungin, US-based researchers have declared thatCosts and outcomes for CAP treatments in France, "despite an increase in drug costs, treating confirmedBelgium, the US and Germany candidaemia with anidulafungin is a cost-savings

strategy".3Macrolidea β-lactamb MoxifloxacinRecognising the costly, as well as serious, nature ofCountry:

candidaemia, the researchers constructed a decisionFrance tree to compare anidulafungin with fluconazole in adultCost (€) 276.56 278.64 161.40 patients with candidaemia or other forms of invasiveFirst-line failure 24.6 17.2 5.2 candidiasis. Outcomes and treatment data was obtainedrate (%)

from a randomised controlled trial, resource use andHospitalisation rate (%) 4.9 5.5 1.5costs from a hospital database, renal toxicity and cost

Belgium data gained from the literature, and drug costs fromCost (€) 191.43 179.72 134.64 standard US publishing sources.First-line failure 18.1 10.0 5.0 Anidulafungin was associated with a greater rate ofrate (%)

treatment success than fluconazole (74% vs 57%).Hospitalisation rate (%) 3.6 3.1 1.2Furthermore, overall treatment costs were lower with

US anidulafungin than with fluconazole ($US72 729 vsCost ($) 876.33 881.94 719.86 $US80 257).First-line failure 18.3 16.9 5.1rate (%) After-flu allocation of antibacterials analysed

Hospitalisation rate (%) 2.1 3.5 1.1 A model of the healthcare utilisation of antibacterialsGermany during an influenza pandemic has identified several

drugs which would be potentially cost-effective in suchCost (€) 250.59 268.91 240.60circumstances, and indicated that a simplified riskFirst-line failure 14.0 16.1 5.1

rate (%) stratification approach would be suitable for determiningHospitalisation rate (%) 2.8 3.6 1.5 the provision of these drugs.4

UK- and US-based researchers from Wyeth useda clarithromycin: France, Belgium; azithromycin: US; roxithromycin:Germany microbiological, epidemiological and cost data from theb amoxicillin/clavulanic acid: France, Belgium, US; amoxicillin: Germany literature, the Internet and company resources to

construct the model; US requirements were determinedto be 40% of the global need. In the US, postinfluenzaMoxifloxacin remained the dominant strategy,bacterial CAP was predicted to afflict 4.2–10.2 millionirrespective of the prevailing antimicrobial resistancepeople, with an associated cost of $US8.8–20 billion. Ofrates in each country, but the strength of the dominancethese cases, 45%–69% would be due to S. aureus, andwas influenced by these rates. In France and the US,

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Inpharma 6 Oct 2007 No. 16081173-8324/10/1608-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved

Single Article

* Theravance; preregistration for skin and soft tissue infections, and88% of those cases due to MRSA. Less expensive broad-phase III for meticillin-resistant Staphylococcus aureus infections, inspectrum antibacterials would provide adequatethe EU and the UStreatment of a majority of patients, mainly those in the** Assessment of TeLAvancin in complicated Skin and skin structurefirst wave of infections. However, for 350 000 to infections; see Inpharma 1587 p7–8; see Inpharma 1587 p7-8;

1.2 million patients with bacterial CAP, mainly in the 801069502 for a feature article on these studiessecond wave, antibacterials covering MRSA would be † costs included infection-related length of stay, daily hospital bedpreferable. costs, concomitant antibacterial costs

Potentially cost-effective antibacterials included: ‡ sponsored by Astellas Pharma and Theravance• tigecycline

1. Martin M, et al. Cost-effectiveness of moxifloxacin for the treatment of• ceftriaxone community-acquired pneumonia in countries with differing levels of

antimicrobial resistance. 47th Interscience Conference on Antimicrobial Agents• levofloxacinand Chemotherapy : 467 (plus poster) abstr. O-1863, 17 Sep 2007.• azithromycin + ceftriaxone 2. Laohavaleeson S, et al. Cost effectivenes of telavancin vs. vancomycin for the

• levofloxacin + ceftriaxone treatment of complicated skin and skin structure infections. 47th InterscienceConference on Antimicrobial Agents and Chemotherapy : 469 (plus poster)• vancomycin + levofloxacinabstr. O-1871, 17 Sep 2007.A simplified risk stratification factoring in age, weight, 3. Earnshaw SR, et al. Cost effectiveness of anidulafungin therapy in confirmedcandidemia and other forms of invasive candidiasis. 47th Intersciencechronic obstructive pulmonary disease, diabetes andConference on Antimicrobial Agents and Chemotherapy : 468, 17 Sep 2007.ischaemic heart disease, was recommended as a more

4. McIntosh EDG, et al. Pandemic flu preparedness and antibiotics: projecteduseful approach to antibacterial provision, than random health care utilisation and recommendation. 47th Interscience Conference on

Antimicrobial Agents and Chemotherapy : 470, 17 Sep 2007.or sequential strategies, the current standard of care,801099053stock rotation, the use diagnostic tests, or antibacterial

use only in the second wave.

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