Health economics matters in the nanomaterial world: Cost-effectiveness of utilizing an inhalable antibacterial nanomaterial for the treatment of multidrug-resistant pneumonia

ABSTRACT

Bacterial pathogens rapidly develop resistance to clinically approved antibiotics. Together with the subsiding economic incentives for the development of newer and more effective antibiotic therapies, this threatens to cause a bacterial disease pandemic in the next 30 years. For this reason, timely analyses of various scientific and socioeconomic aspects of alternatives to traditional antibiotic therapies are needed. Here, pharmacoeconomic cost-of-illness, cost-effectiveness and price sensitivity analyses were performed to assess the impact of multidrug resistance of Pseudomonas aeruginosa implicated in pneumonia on healthcare systems of the United States and of the developing countries. The assessment was extended to include the effects of various therapies for this condition, one group of which consisted of colistin administered intravenously or with the use of a nebulizer and another therapy coming in the form of an inhalable colloidal formulation comprising biocompatible antibacterial nanoparticles. Both colistin and nanoparticle therapies produced net gain per quality adjusted life year (QALY) saved for patients with pneumonia caused by multidrug-resistant P. aeruginosa in the United States. In the developing world, in contrast, where the pricing sensitivity is shown to be higher, there is a positive cost of $8800 and $3600 per QALY saved associated with the use of colistin at a price adjusted to the local economy and administered through a parenteral route or through a nebulizer, respectively. Simultaneously, thanks to the higher affordability compensating for the 15% lower clinical efficacy assumed in the model, there is a net gain of $10,100 per QALY saved with the use of the nanoparticle formulation, translating to $52,000 gain for each life saved by the treatment. In conclusion, inorganic nanoparticle therapies for infectious disease are not only more immune to eliciting resistance than small-molecule antibiotics, but are also more applicable in low-cost healthcare systems of the developing world. The current generation of antibiotic therapies is cost-effective in high-cost healthcare systems, such as the one of the United States, but its application in more frugal settings, where pricing is as important as efficacy, comes with tremendous costs. These results demonstrate the considerable disparity in profit margin flexibility depending on the wealth and the size of the healthcare economy, which contributes daily to the widening of the gap between the rich and the poor.