Individualized short antibiotic course deemed cost effective for VAP in three countries

Key takeaways:

• Each country represented a different income level.
• Thailand had the highest likelihood of the short antibiotic course being cost-effective based on willingness-to-pay thresholds.

In Nepal, Thailand and Singapore, an individualized short antibiotic course vs. usual care was estimated to be cost effective for the treatment of ventilator-associated pneumonia, according to findings published in The Lancet Global Health.

As Healio previously reported, an individualized short antibiotic course was noninferior to usual care in those with ventilator-associated pneumonia (VAP) when measuring mortality and pneumonia recurrence at day 60 in the multicenter, individually randomized, open-label, non-inferiority phase 4 REGARD-VAP trial.

“We found that an individualized 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,” Yiying Cai, PhD, assistant professor and lead researcher from the Health Services and Systems Research Program at Duke-NUS Medical School, and colleagues wrote.

Using REGARD-VAP trial data, Cai and colleagues conducted an economic analysis to determine whether an individualized short antibiotic course vs. usual care in patients with VAP is cost-effective in three income categories: low-income (Nepal), middle-income (Thailand) and high-income (Singapore).

In each country, the short antibiotic course resulted in greater mean life-years vs. usual care. Switching to cost, researchers found that the short antibiotic course yielded lower mean health care costs than usual care in Singapore only.

Singapore had the highest incremental net monetary benefit of adopting an individualized short antibiotic course at $5,156 (95% uncertainty intervals [UI], –$45,805 to $56,117), according to the study. Thailand had the second highest associated incremental net monetary benefit at $804 (95% UI, –$6,245 to $7,852) while Nepal had the third highest benefit at $41 (95% UI, –$2,308 to $2,390).

The incremental cost-effectiveness ratio of the individualized short antibiotic course vs. usual care varied across the three countries but was deemed cost-effective in each location. Researchers observed the highest incremental cost-effectiveness ratio in Nepal at $1,086, followed by Thailand at $263 and Singapore at –$6,069. Notably, Thailand had the highest likelihood of the short antibiotic course being cost-effective based on willingness-to-pay thresholds (60.5%), followed by Singapore (55.2%) and Nepal (50.3%).

When evaluating the likelihood of the short antibiotic course being cost-saving, researchers reported the highest likelihood in Singapore (50.2%), followed closely by Thailand (49.1%) and then Nepal (43.2%).

Lastly, three factors — “reducing uncertainties for mortality risk, costs of bed days and variable costs” — emerged during value of information analysis as holding the most “value for decision-making.”

“When considered alongside the potential positive externalities of lowered antimicrobial resistance due to reduced antibiotic use, our results provide some confidence to decision-makers that the adoption of an individualized short-course antibiotic strategy to guide antibiotic prescribing in patients with VAP across the various resource settings would be a rational decision from a health system perspective,” Cai and colleagues wrote.

Reference:

• Shorter, smarter, safer: Short-course antibiotics can revolutionize healthcare. https://www.eurekalert.org/news-releases/1071050. Published Jan. 20, 2025. Accessed Jan. 22, 2025.