Evaluating the health economic impact of cefepime/enmetazobactam in complicated urinary tract infections in the German setting: a cost analysis from payer perspective

Objectives: Complicated urinary tract infections (cUTIs) are ubiquitous, associated with healthcare resources, and demand effective antibiotic treatment to prevent clinical failure and relapse. Evidence on health economic implications of treatment options remains limited. Recent studies have shown that cefepime/enmetazobactam was superior to piperacillin/tazobactam regarding the combined endpoints clinical cure and microbiological eradication, the latter being closely linked to reduced relapse rates. Therefore, we perform a health economic evaluation of cefepime/enmetazobactam vs. piperacillin/tazobactam for cUTI from a German payer perspective. Methods: To assess monetary impacts of both therapies, we conducted a semi-structured literature review for costs of (relapsed) cUTI. Subsequently, we adjusted international costs to the German healthcare system using European price levels of the Organisation for Economic Cooperation and Development. These built the basis of a comparative health economic analysis using a decision tree incorporating outcome probabilities and relapse rates for both antibiotics. Lastly, we validated the analysis using publicly available remuneration data from German hospitals. Results: Literature revealed international costs of €5,394 and €6,675 per patient without and with clinical relapse, converting to €5,137.14 and €6,357.14 in Germany, respectively. Considering the probability of occurrence of clinical cure, microbiological persistence, and relapse rates, average treatment costs per patient for cefepime/enmetazobactam amount to €5,332.12 compared to €5,414.83 for piperacillin/tazobactam. Conclusion: The analysis shows that a higher probability of relapse after antibiotic therapy might be associated with an increase in treatment costs within the German healthcare system. Although per-patient cost differences between cefepime/enmetazobactam and piperacillin/tazobactam are moderate, their cumulative impact at the population level could be substantial, emphasizing the broader health-economic relevance of treatment choice for cUTI.