头孢地尔治疗确诊与疑似耐碳青霉烯类革兰氏阴性菌严重感染的成本-效果分析OA

OBJECTIVE To evaluate the cost-effectiveness of cefiderocol versus best available therapy(BAT)or standard-of-care(SOC)for the treatment of confirmed or suspected carbapenem-resistant Gram-negative bacterial(CRGNB)serious infections from the perspective of the Chinese healthcare system,and to explore its reasonable pricing.METHODS A decision tree model was constructed based on data from two phase Ⅲ clinical trials(CREDIBLE-CR and GAME CHANGER)to simulate the cost-effectiveness of cefiderocol in two scenarios:salvage therapy for confirmed CRGNB infection(scenario 1)and empirical therapy for suspected CRGNB infection(scenario 2).The primary outcome measure was the incremental cost-effectiveness ratio(ICER).The willingness-to-pay(WTP)was set at 1 to 3 times China's per capita GDP in 2024.To verify the robustness of the results,one-way and probabilistic sensitivity analyses were conducted,and based on these,a reasonable price range for cefiderocol in the Chinese market was explored.RESULTS The results for scenario 1 showed that the clinical cure rate in the cefiderocol group was higher than that in the BAT group(47.50%vs.34.21%),but its ICER was 415 065.03 yuan per cured case,exceeding three times China's GDP per capita.Scenario 2 revealed that the ICER for cefiderocol relative to SOC was as high as 1 362 446.16 yuan per cured case,far exceeding the WTP.Sensitivity analysis indicated that the treatment duration and price of cefiderocol were key factors affecting its cost-effectiveness.In the two scenarios described above,the unit price of cefiderocol must fall below 683.47 and 242.00 yuan/g,respectively,to be considered cost-effective.CONCLUSIONS Based on the current market price,cefiderocol lacks sufficient cost-effectiveness for treating confirmed or suspected CRGNB serious infections within China's healthcare system.To improve its accessibility,price negotiations or a tiered medical insurance payment strategy are required.