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Survey: Physicians Likely to Use High-Priced Antibiotics for Drug-Resistant Infections

Hospital pharmacy directors are less receptive (October 8)

Decision Resources, a research and advisory firm located in Burlington, Mass., finds that a majority of surveyed infectious disease (ID) specialists is willing to prescribe new antibiotics developed under the Infectious Diseases Society of America’s proposed Limited Population Antibacterial Drug (LPAD) approval pathway and costing $15,000 or more for a course of therapy if the drugs demonstrate superiority in improving clinical cure rates or in reducing mortality rates in patients with multidrug-resistant gram-negative infections (GNIs).

However, given that cost-related factors — namely direct acquisition costs and cost per patient, including treatment and secondary costs — are important considerations in formulary decision making, surveyed hospital pharmacy directors (PDs) are less receptive to formulary inclusion of an LPAD-approved agent costing $15,000 or more, irrespective of the level of demonstrated superiority.

The report also finds that, with regard to the formulary status of currently marketed antibiotics, premium-priced branded antibiotics — such as Invanz (ertapenem, Merck), Doribax (doripenem, Janssen), Avelox (moxifloxacin, Bayer), Tygacil (tigecycline, Pfizer), and Teflaro (ceftaroline fosamil, Forest) — continue to be subject to prescribing restrictions, likely in efforts to limit inappropriate use, to prevent the emergence of drug resistance, and to reduce treatment costs.

Further, the report finds that carbapenems with generically available formulations are increasingly included on hospital formularies without restrictions. Approximately half of surveyed physicians and nearly two-thirds of hospital PDs indicate that meropenem and imipenem/cilastatin are unrestricted on their hospital’s formulary, likely a reflection of the increasing incidence of difficult-to-treat GNIs and the limited number of available treatment options.

When asked about their willingness to include emerging therapies –– such as ceftazidime/avibactam (AstraZeneca/Forest), ceftolozane/tazobactam (Cubist), eravacycline (Tetraphase), and plazomicin (Achaogen) –– on hospital formularies, surveyed hospital PDs indicated that the inclusion of these therapies will be largely influenced by pricing relative to marketed competitors. Among surveyed hospital PDs who anticipate including these emerging therapies on their hospital formularies, most expect the drugs to be included with prescribing restrictions, such as requiring a prior ID consult or limiting use to microbiologically confirmed infections due to susceptible pathogens.

[Source: Decision Resources; October 8, 2013.]

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