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.

中文翻译：

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治疗呼吸机相关性肺炎的短程抗生素治疗策略的成本效益：REGARD-VAP 试验的经济分析。


背景 REGARD-VAP 试验表明，个体化缩短抗生素治疗对呼吸机相关性肺炎 （VAP） 患者的死亡率和肺炎复发率不劣于常规护理。我们旨在评估这项计划的经济分析中个体化缩短抗生素治疗方法的成本效益。方法 REGARD-VAP 是一项 4 期、多中心、开放标签、随机试验，旨在评估治疗 VAP 的短程抗生素治疗策略。在这项有计划的经济分析中，我们将 REGARD-VAP 试验的数据拟合了一个决策树，以估计在尼泊尔、新加坡和泰国，与卫生系统角度的常规护理相比，个体化短程治疗 VAP 的成本效益。根据相关的支付意愿阈值报告了增量成本效益比 （ICER） 和具有 95% 不确定性区间 （UI） 的增量净货币收益。使用情景分析评估参数不确定性。进行了信息分析的价值。结果采用个体化短程治疗对尼泊尔 （ICER=1086 美元;百分比成本效益 = 50·3%）、新加坡 （ICER=-6069 美元;百分比成本效益 = 55·2%） 和泰国 （ICER=263 美元;百分比成本效益 = 60·5%） 具有成本效益。相关的增量净货币收益在尼泊尔为 41 美元（95% UI -2308 至 2390），新加坡为 5156 美元（-45 805 至 56 117），泰国为 804 美元（-6245 至 7852）。信息分析的价值表明，减少死亡概率、睡日成本和可变成本的不确定性对决策很有价值。 解释 我们发现，VAP 患者的个体化短程抗生素策略在高收入、中等收入和低收入环境中可能具有成本效益，尽管存在明显的不确定性。考虑到减少抗菌药物使用的积极外部性，我们的研究结果增强了考虑采用短程抗生素的政策制定者的信心。资助英国医学研究委员会、新加坡国家医学研究委员会和惠康信托基金。