Supplementary data: Cost–effectiveness of imipenem/cilastatin/relebactam for hospital-acquired and ventilator-associated bacterial pneumonia

These are peer-reviewed supplementary materials for the article 'Cost–effectiveness of imipenem/cilastatin/relebactam for hospital-acquired and ventilator-associated bacterial pneumonia' published in the Journal of Comparative Effectiveness Research.
Appendix 1: RESTORE IMI-2 Eligibility CriteriaAppendix 2: US age- and sex-matched general population mortality (used in the long-term Markov model)Appendix 3: Model parameters with uncertainty informationAppendix 4: Probabilistic Sensitivity Analysis: Cost-effectiveness acceptability curveAppendix 5: Scenario analysisAppendix 6: Indirect Evidence’s Effect on Model ResultsAim: This study evaluates the cost–effectiveness of imipenem/cilastatin/relebactam (IMI/REL) for treating hospital-acquired bacterial pneumonia and ventilator-associated bacterial pneumonia (HABP/VABP) in an ‘early adjustment prescribing scenario’. Methods: An economic model was constructed to compare two strategies: continuation of empiric piperacillin/tazobactam (PIP/TAZ) versus early adjustment to IMI/REL. A decision tree was used to depict the hospitalization period, and a Markov model used to capture long-term outcomes. Results: IMI/REL generated more quality-adjusted life years than PIP/TAZ, at an increased cost per patient. The incremental cost–effectiveness ratio of $17,529 per QALY is below the typical US willingness-to-pay threshold. Conclusion: IMI/RELmay represent a cost-effective treatment for payers and a valuable option for clinicians, when considered alongside patient risk factors, local epidemiology, and susceptibility data.

本材料为发表于《比较疗效研究杂志》（Journal of Comparative Effectiveness Research）的论文《亚胺培南/西司他丁/雷巴坦（imipenem/cilastatin/relebactam）治疗医院获得性细菌性肺炎与呼吸机相关性细菌性肺炎的成本效益》的同行评议补充资料。

附录1：RESTORE IMI-2 入选标准
附录2：美国年龄与性别匹配的普通人群死亡率（用于长期马尔可夫模型）
附录3：带不确定性信息的模型参数
附录4：概率敏感性分析：成本效益可接受性曲线
附录5：情景分析
附录6：间接证据对模型结果的影响

研究目的：本研究旨在评估「早期调整给药方案场景」下，亚胺培南/西司他丁/雷巴坦（imipenem/cilastatin/relebactam, IMI/REL）治疗医院获得性细菌性肺炎（hospital-acquired bacterial pneumonia, HABP）与呼吸机相关性细菌性肺炎（ventilator-associated bacterial pneumonia, VABP）的成本效益。

研究方法：本研究构建经济学模型以对比两种治疗策略：延续经验性哌拉西林/他唑巴坦（piperacillin/tazobactam, PIP/TAZ）治疗，与早期调整为IMI/REL治疗。采用决策树刻画住院周期，使用马尔可夫模型（Markov model）捕捉长期临床转归。

研究结果：相较于PIP/TAZ，IMI/REL可使每位患者获得更多的质量调整生命年（quality-adjusted life years, QALY），但同时也增加了患者治疗成本。每QALY的增量成本效益比为17529美元，低于美国典型的医疗支付意愿阈值。

研究结论：结合患者危险因素、当地流行病学特征与药敏检测数据综合考量后，IMI/REL可为医疗支付方提供具备成本效益的治疗方案，同时也可为临床医师提供极具临床价值的治疗选择。