The cost-effectiveness of empirical antibiotic treatments for high-risk febrile neutropenic patients: A decision analytic model


Abstract

Purpose: Febrile neutropenia has a significant clinical and economic impact on cancer patients. This study evaluates the cost-effectiveness of different current empiric antibiotic treatments.

Methods: A decision analytic model was constructed to compare the use of cefepime, meropenem, imipenem/cilastatin, and piperacillin/tazobactam for treatment of high-risk patients. The analysis was performed from the perspective of U.S.-based hospitals. The time horizon was defined to be a single febrile neutropenia episode. Cost-effectiveness was determined by calculating costs and deaths averted. Cost-effectiveness acceptability curves for various willingness-to-pay thresholds (WTP), were used to address the uncertainty in cost-effectiveness.

Results: The base-case analysis results showed that treatments were equally effective but differed mainly in their cost. In increasing order: treatment with imipenem/cilastatin cost $52,647, cefepime $57,270, piperacillin/tazobactam $57,277, and meropenem $63,778. In the probabilistic analysis, mean costs were $52,554 (CI: $52,242-$52,866) for imipenem/cilastatin, $57,272 (CI: $56,951-$57,593) for cefepime, $57,294 (CI: $56,978-$57,611) for piperacillin/tazobactam, and $63,690 (CI: $63,370-$64,009) for meropenem. Furthermore, with a WTP set at $0 to $50,000, imipenem/cilastatin was cost-effective in 66.2% to 66.3% of simulations compared to all other high-risk options.

Discussion: Imipenem/cilastatin is a cost-effective strategy and results in considerable health care cost-savings at various WTP thresholds. Cost-effectiveness analyses can be used to differentiate the treatments of febrile neutropenia in high-risk patients.

Conflict of interest statement

The authors have no funding and conflict of interest to disclose.

Figures

Figure 1
Figure 1
Decision Tree Model for High-Risk Patients. The squares indicate the decision to use cefepime, imipenem/cilastatin, meropenem and piperacillin/tazobactam as treatment for high-risk patients. The circles indicate chance nodes, and the triangles indicate terminal nodes.
Figure 2
Figure 2
Incremental Cost-Effectiveness Curves. a: Imipenem Cilastatin vs Cefepime. b: Imipenem/cilastatin vs Meropenem. c: Imipenem/cilastatin vs Piperacillin/Tazobactam.
Figure 2 (Continued)
Figure 2 (Continued)
Incremental Cost-Effectiveness Curves. a: Imipenem Cilastatin vs Cefepime. b: Imipenem/cilastatin vs Meropenem. c: Imipenem/cilastatin vs Piperacillin/Tazobactam.
Figure 2 (Continued)
Figure 2 (Continued)
Incremental Cost-Effectiveness Curves. a: Imipenem Cilastatin vs Cefepime. b: Imipenem/cilastatin vs Meropenem. c: Imipenem/cilastatin vs Piperacillin/Tazobactam.
Figure 3
Figure 3
Cost-effectiveness acceptability curves for various willingness-to-pay thresholds for high-risk patients. These curves show the percent of the 10,000 simulations at which each treatment strategy was cost-effective.
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