头孢哌酮/舒巴坦与亚胺培南/西司他丁和哌拉西林/他唑巴坦治疗革兰阴性菌感染的药物经济学评价  

Pharmacoeconomics on treatment of gram-negative bacteria infections with cefoperazone-sulbactam,imipenem-cilastatin,and piperacillin-tazobactam

作　　者：唐可京[1] 罗益锋[1] 苏霞 贺蓓[3] 时国朝[4] 宋立强[5] 文富强[6] 吕晓菊[7] 陈佰义[8] 熊盛道[9] 赵建平[9] 张天托[10] 周建英[11] 俞云松[12] 曹彬[13] 肖伟[14] 潘频华[15] 施毅[16] 林其昌[17] 陈一强[18] 倪语星[19] 谢灿茂[1] 

机构地区：[1]中山大学附属第一医院呼吸科,广东广州510080 [2]恩远医药科技(北京)有限公司,北京100024 [3]北京大学第三医院呼吸内科,北京100191 [4]上海交通大学医学院附属瑞金医院呼吸科,上海200025 [5]西京医院呼吸内科,陕西西安710032 [6]四川大学华西医院呼吸内科,四川成都610041 [7]四川大学华西医院感染性疾病中心,四川成都610041 [8]中国医科大学附属第一医院感染性疾病科,辽宁沈阳110001 [9]华中科技大学同济医学院附属同济医院呼吸内科,湖北武汉430030 [10]中山大学附属第三医院呼吸内科,广东广州510630 [11]浙江大学医学院附属第一医院呼吸内科,浙江杭州310003 [12]浙江大学医学院附属邵逸夫医院感染科,浙江杭州310016 [13]北京朝阳医院感染和临床微生物科,北京100020 [14]山东大学齐鲁医院呼吸科,山东济南250012 [15]中南大学湘雅医院呼吸内科,湖南长沙410008 [16]南京军区南京总医院呼吸科,江苏南京210002 [17]福建医科大学附属第一医院呼吸内科,福建福州350005 [18]广西医科大学附属第一医院呼吸内科,广西南宁530021 [19]上海交通大学医学院附属瑞金医院临床微生物科,上海200025

出　　处：《中华医院感染学杂志》2017年第15期3385-3391,共7页Chinese Journal of Nosocomiology

摘　　要：目的评价头孢哌酮/舒巴坦、亚胺培南/西司他丁及哌拉西林/他唑巴坦治疗革兰阴性菌感染的有效性和经济性。方法采用非随机观察性研究,选取2012年1月1日-2016年5月11日期间,使用头孢哌酮/舒巴坦、亚胺培南/西司他丁或哌拉西林/他唑巴坦进行治疗的革兰阴性菌感染住院患者322例的抗菌药物治疗数据,采用成本效果分析进行经济学评价。结果本研究数据来源于一项大样本、非随机主动监测研究课题,原始数据组间协变量存在不均衡现象,采用倾向性评分匹配后,组间协变量不均衡现象得到显著改善。匹配后以目标抗菌药物成本进行经济学分析,头孢哌酮/舒巴坦VS亚胺培南/西司他丁时,头孢哌酮/舒巴坦每获得1%临床疗效、微生物疗效、综合疗效、30d生存率仅需39.15元、51.02元、52.61元、40.09元,而亚胺培南/西司他丁则需要75.54元、81.28元、83.39元、72.15元;头孢哌酮/舒巴坦VS哌拉西林/他唑巴坦时,头孢哌酮/舒巴坦每获得1%临床疗效、微生物疗效、综合疗效、30d生存率仅需36.94元、46.80元、48.40元、33.42元,而哌拉西林/他唑巴坦则需要99.99元、117.64元、121.21元、95.23元。四种成本效果分析均显示头孢哌酮/舒巴坦具有明显的经济学优势。在同等疗效下,头孢哌酮/舒巴坦成本约是哌拉西林/他唑巴坦和亚胺培南/西司他丁的1/3-1/2。采用疗效的95%可信限进行敏感性分析,结论仍然成立。结论头孢哌酮/舒巴坦在治疗革兰阴性菌(包括多重耐药菌)感染时更具有成本效果优势。OBJECTIVE To evaluate the efficacy and economy of cefoperazone-sulbactam,imipenem-cilastatin,and piperacillin-tazobactam in treatment of gram-negative bacteria infections.METHODS By means of non-random observational study,the data of antibiotics therapy were collected from 322 patients with gram-negative bacteria infections who were hospitalized from Jan 1,2012 to May 11,2016 and were treated with cefoperazone-sulbactam,imipenem-cilastatin,and piperacillin-tazobactam.The pharmacoeconomics were evaluated with the use of cost-effectiveness analysis method.RESULTS The data were obtained from a large sample,non-random,and active surveillance study,the between-group covariate imbalance phenomenon existed in the original data,and the betweengroup covariate imbalance phenomenon was remarkably improved after they were matched by using propensity scoring method.After the matching,the economic analysis of costs of target antibiotics was carried out after the matching.As compared with cefoperazone-sulbactam and imipenem-cilastatin,cefoperazone-sulbactam that obtained every 1% clinical efficacy,microbial efficacy,comprehensive effect,and 30-day survival rate only needed 39.15 yuan,51.02 yuan,52.61 yuan,and 40.09 yuan,respectively;while the imipenem-cilastatin needed 75.54 yuan,81.28 yuan,83.39 yuan,and 72.15 yuan respectively.As compared with cefoperazone-sulbactam and piperacillin-tazobactam,cefoperazone-sulbactam that obtained every 1% clinical efficacy,microbial efficacy,comprehensive effect,and 30-day survival rate only needed 36.94 yuan,46.80 yuan,48.40 yuan,and 33.42 yuan,respectively;while piperacillin-tazobactam needed 99.99 yuan,117.64 yuan,121.21 yuan,and 95.23 yuan,respectively.The four cost-effectiveness analyses showed that cefoperazone-sulbactam had obvious economic advantages.Under the circumstances of the same efficacy,the cost of cefoperazone-sulbactam was 1/3~1/2of the cost of piperacillin-tazobactam and imipenem-cilastatin.The sensitivity analysis based on the 95% confidence limit of efficacy showed that t

关 键 词：头孢哌酮/舒巴坦 亚胺培南/西司他丁 哌拉西林/他唑巴坦 多重耐药菌 经济性 

分 类 号：R446.5[医药卫生—诊断学]