Economic evaluation of ceftazidime and meropenem for the treatment of severe melioidosis, Northeastern Region in Thaland

Abstract

This economic evaluation aims to determine the incremental cost-effectiveness of meropenem if used instead of ceftazidime in treatment of severe melioidosis from the perspective of regional hospitals in Thailand. A modelling-based cost-effectiveness analysis was performed based on a published randomised controlled trial conducted in Sapprasitprasong Hospital. A decision tree was used to represent the course of melioidosis treatment. Two major costs incurred to the hospital were included in the analysis; hospitalization cost and drug cost. The result is expressed as cost per incremental life year saved. To ensure the reliability of study results, extensive sensitivity analyses were used to handle uncertainties in model parameters. Results from this preliminary study suggest that the incremental cost for treatment with meropenem instead of ceftazidime is 31,000 Baht. Meropenem increases life years by 0.34 years compared to ceftazidime. Meropenem is not a dominant choice of treatment because it provides higher effectiveness but with higher cost of treatment; the incremental cost effectiveness is 90,338 Baht per one additional life year saved. One way sensitivity analysis showed the result was highly sensitive to probability of death within 48 hours and death rates after treatment failure. Probabilistic sensitivity analysis suggested that although the baseline result suggests that meropenem is more cost-effective as the ICER is lower than the WTP threshold of 100,000 Baht, there is a high probability that this conclusion might be wrong due to the uncertainty in many parameter estimates. Therefore, it is inconclusive that meropenem should be adopted to replace the standard treatment from this analysis. There is an ongoing randomised controlled trial comparing the effectiveness of ceftazidime and meropenem; when the trial result is available this analysis will be repeated for more robust results.