Cost-Effectiveness of Sulbactam-durlobactam Compared with Colistin for Treating Carbapenem-Resistant Acinetobacter baumannii Infections in Critical Care Settings in the United States
- 1Department of Pharmacy Practice and Clinical Research, College of Pharmacy, University of Rhode Island, Kingston, 02881, RI, USA
Abstract
ObjectiveCarbapenem-resistant Acinetobacter baumannii (CRAB) infections present a significant public health challenge in the United States due to multidrug resistance, substantial added inpatient costs, and subsequently high mortality rates.
MethodA decision-analytic model was developed to evaluate the cost-effectiveness of sulbactam-durlobactam compared to colistin for treating CRAB infections, using data from the Acinetobacter Treatment Trial Against Colistin (ATTACK) trial, in which patients received either sulbactam-durlobactam or colistin alongside imipenem-cilastatin. The model incorporated survival rates, clinical outcomes (complete or incomplete cure), and the incidence and costs of acute kidney injury, which is more frequent in colistin-treated patients. Deterministic sensitivity analysis and two scenario analyses were performed.
ResultsThe base case analysis estimated an expected per-patient cost of $57,887 for sulbactam-durlobactam compared to $55,157 for colistin. Patients treated with sulbactam-durlobactam had higher survival than those treated with colistin (0.66 versus 0.46), corresponding to 0.19 additional life saved per patient. The incremental cost-effectiveness ratio (ICER) for sulbactam-durlobactam compared with colistin was $14,097 per additional life saved. The ICER was most sensitive to the proportion of survivors with incomplete clinical cure for both treatments, the costs of sulbactam-durlobactam and cefiderocol, and survival outcomes in patients treated with sulbactam-durlobactam. Scenario analyses showed that the cost-effectiveness of sulbactam-durlobactam was sensitive to clinical cure outcomes, with ICERs ranging from $69,758 per additional life saved to dominance favoring sulbactam-durlobactam under different assumptions.
ConclusionsAlthough treatment costs were higher, sulbactam-durlobactam has a favorable cost-effectiveness profile as compared with colistin when accounting for the costs of managing acute kidney injury.
Related
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- Carbapenem resistance in pediatric Acinetobacter baumannii urinary tract infections: molecular determinants.
- Sulbactam/Durlobactam for CRAB Bacteremia and Pneumonia in a Critically Ill Patient in China: A Case Report.
- Carbapenem-resistant Acinetobacter baumannii infections in intensive care units: incidence, infection prevention and control, and antimicrobial stewardship practices in the cross-border region between Italy and France, 2019–2022
- When the Antibiogram Offers Nothing Else: Ceftriaxone–Sulbactam–Disodium EDTA With Intravenous Colistin in Two Neonates With Metallo‐β‐Lactamase‐Producing Acinetobacter baumannii Meningitis
BibTeX
@misc{ologunowa2026costeffectiveness,
title = {{Cost-Effectiveness of Sulbactam-durlobactam Compared with Colistin for Treating Carbapenem-Resistant Acinetobacter baumannii Infections in Critical Care Settings in the United States}},
author = {A. Ologunowa and A. Caffrey and S. Cohen and S. Kogut},
howpublished = {medRxiv},
year = {2026},
month = sep,
doi = {10.64898/2026.09.13.26362951},
url = {https://www.medrxiv.org/content/10.64898/2026.09.13.26362951v1},
note = {CC BY},
}
RIS
TY - UNPB
TI - Cost-Effectiveness of Sulbactam-durlobactam Compared with Colistin for Treating Carbapenem-Resistant Acinetobacter baumannii Infections in Critical Care Settings in the United States
AU - A. Ologunowa
AU - A. Caffrey
AU - S. Cohen
AU - S. Kogut
PY - 2026
DA - 2026/09/13
PB - medRxiv
DO - 10.64898/2026.09.13.26362951
UR - https://www.medrxiv.org/content/10.64898/2026.09.13.26362951v1
AB - ObjectiveCarbapenem-resistant Acinetobacter baumannii (CRAB) infections present a significant public health challenge in the United States due to multidrug resistance, substantial added inpatient costs, and subsequently high mortality rates. MethodA decision-analytic model was developed to evaluate the cost-effectiveness of sulbactam-durlobactam compared to colistin for treating CRAB infections, using data from the Acinetobacter Treatment Trial Against Colistin (ATTACK) trial, in which patients received either sulbactam-durlobactam or colistin alongside imipenem-cilastatin. The model incorporated survival rates, clinical outcomes (complete or incomplete cure), and the incidence and costs of acute kidney injury, which is more frequent in colistin-treated patients. Deterministic sensitivity analysis and two scenario analyses were performed. ResultsThe base case analysis estimated an expected per-patient cost of $57,887 for sulbactam-durlobactam compared to $55,157 for colistin. Patients treated with sulbactam-durlobactam had higher survival than those treated with colistin (0.66 versus 0.46), corresponding to 0.19 additional life saved per patient. The incremental cost-effectiveness ratio (ICER) for sulbactam-durlobactam compared with colistin was $14,097 per additional life saved. The ICER was most sensitive to the proportion of survivors with incomplete clinical cure for both treatments, the costs of sulbactam-durlobactam and cefiderocol, and survival outcomes in patients treated with sulbactam-durlobactam. Scenario analyses showed that the cost-effectiveness of sulbactam-durlobactam was sensitive to clinical cure outcomes, with ICERs ranging from $69,758 per additional life saved to dominance favoring sulbactam-durlobactam under different assumptions. ConclusionsAlthough treatment costs were higher, sulbactam-durlobactam has a favorable cost-effectiveness profile as compared with colistin when accounting for the costs of managing acute kidney injury.
ER -