Cost-effectiveness of a short-course antibiotic treatment strategy for the treatment of ventilator-associated pneumonia: an economic analysis of the REGARD-VAP trial
1
Issued Date
2024-12-01
Resource Type
ISSN
2572116X
eISSN
2214109X
Scopus ID
2-s2.0-85209565968
Pubmed ID
39510104
Journal Title
The Lancet Global Health
Volume
12
Issue
12
Start Page
e2059
End Page
e2067
Rights Holder(s)
SCOPUS
Bibliographic Citation
The Lancet Global Health Vol.12 No.12 (2024) , e2059-e2067
Suggested Citation
Cai Y., Booraphun S., Li A.Y., Kayastha G., Tambyah P.A., Cooper B.S., Graves N., Mo Y. Cost-effectiveness of a short-course antibiotic treatment strategy for the treatment of ventilator-associated pneumonia: an economic analysis of the REGARD-VAP trial. The Lancet Global Health Vol.12 No.12 (2024) , e2059-e2067. e2067. doi:10.1016/S2214-109X(24)00327-9 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/102171
Title
Cost-effectiveness of a short-course antibiotic treatment strategy for the treatment of ventilator-associated pneumonia: an economic analysis of the REGARD-VAP trial
Corresponding Author(s)
Other Contributor(s)
Abstract
Background: The REGARD-VAP trial showed that individualised shortened antibiotic therapy was non-inferior to usual care for mortality and pneumonia recurrence in patients with ventilator-associated pneumonia (VAP). We aimed to assess the cost-effectiveness of an individualised shortened antibiotic therapy approach in this planned economic analysis. Methods: REGARD-VAP was a phase 4, multicentre, open-label, randomised trial to assess a short-course antibiotic treatment strategy for treatment of VAP. In this planned economic analysis, we fitted a decision tree with data from the REGARD-VAP trial to estimate the cost-effectiveness of individualised short-course therapy for VAP, compared to usual care from the health system perspective, in Nepal, Singapore, and Thailand. Incremental cost-effectiveness ratios (ICERs) and incremental net monetary benefits with 95% uncertainty intervals (UIs) were reported against relevant willingness-to-pay thresholds. Parameter uncertainties were evaluated using scenario analyses. A value of information analysis was conducted. Findings: Adopting individualised short-course therapy was cost-effective for Nepal (ICER=US$1086; percentage cost-effectiveness=50·3%), Singapore (ICER=–$6069; percentage cost-effectiveness=55·2%), and Thailand (ICER=$263; percentage cost-effectiveness=60·5%). The associated incremental net monetary benefits were $41 (95% UI –2308 to 2390) in Nepal, $5156 (–45 805 to 56 117) in Singapore, and $804 (–6245 to 7852) in Thailand. Value of information analysis showed that reducing uncertainties for mortality probabilities, bed-day costs, and variable costs were valuable for decision making. Interpretation: We found that an individualised short-course antibiotics strategy in patients with VAP is likely to be cost-effective in high-income, middle-income, and low-income settings, although with evident uncertainty. Considered alongside the positive externalities of reduced antimicrobial use, our findings foster confidence in policy makers contemplating adoption of short-course antibiotics. Funding: UK Medical Research Council, Singapore National Medical Research Council, and Wellcome Trust.