A recent economic analysis of the Reducing Antibiotic Treatment Duration for Ventilator-Associated Pneumonia trial showed that an individualized short-course antibiotic treatment strategy for ventilator-associated pneumonia is "likely" cost-effective across high, middle, and low-income settings.
The Reducing Antibiotic Treatment Duration for Ventilator-Associated Pneumonia (REGARD-VAP) trial was a multicenter, open-label, randomized phase IV trial conducted in Nepal, Singapore, and Thailand. It compared an individualized short-course antibiotic treatment approach to usual care in patients with VAP. The study used clinical criteria such as fever resolution and hemodynamic stability to guide the treatment duration.
In a planned economic analysis of the trial published in The Lancet Global Health, the authors reported that the individualized approach yielded incremental cost-effectiveness ratios (ICERs) of $1,086 in Nepal, –$6,069 in Singapore, and $263 in Thailand—all within acceptable willingness-to-pay thresholds. The percentage cost-effectiveness was 50.3% for Nepal, 55.2% for Singapore, and 60.5% for Thailand. Incremental net monetary benefits were estimated at $41 (95% uncertainty interval [UI]: –2,308 to 2,390) in Nepal, $5,156 (95% UI: –45,805 to 56,117) in Singapore, and $804 (95% UI: –6,245 to 7,852) in Thailand.
The findings may provide confidence to decision-makers in adopting short-course antibiotic strategies in this patient population—especially considering the added benefit of reduced antimicrobial resistance—the study authors noted.
Results also showed that the individualized strategy was noninferior to standard care for the 60-day composite endpoint of death or pneumonia recurrence. Notably, the short-course strategy reduced antibiotic treatment days and associated side effects without significantly affecting hospital or intensive care unit (ICU) stays.
"Value of information analysis showed that reducing uncertainties for mortality probabilities, bed-day costs, and variable costs were valuable for decision-making," wrote first author Yiying Cai, PhD, of the Programme in Health Services and Systems Research, Duke-NUS Medical School, National University of Singapore, and colleagues.
The report highlighted several implications for health-care systems associated with the analysis' findings. In Singapore, the individualized strategy was cost-saving, while in Nepal and Thailand, it was considered cost-effective within the respective economic contexts.
VAP remains a critical concern in ICUs, with prolonged antibiotic use contributing to treatment resistance. Current guidelines recommend 7 to 8 days of antibiotic therapy, but the optimal duration has remained unclear. REGARD-VAP is among the first studies to evaluate the cost-effectiveness of a short-course strategy for VAP through a robust, pragmatic randomized controlled trial.
While uncertainties remain, the findings suggest that adopting this shortened approach could benefit health-care systems in diverse resource settings.
The study was funded by the UK Medical Research Council, Singapore National Medical Research Council, and Wellcome Trust. The authors have declared no competing interests.
