三种常用碳青霉烯类抗菌药物治疗呼吸系统和/或泌尿系统细菌感染的循证药物经济学评价  

Evidence-based Pharmacoeconomic Evaluation on Three Kinds of Common Carbapenem Drugs in TreatingRespiratory and/or Urinary Bacterial Infection

作　　者：洪琳 冯建华 洪瑛 邵琼[1] 廖华[2] HONG Lin;FENG Jian-hua;HONG Ying;SHAO Qiong;LIAO Hua(Department of Pharmacy,the Central Hospital of Ezhou,Ezhou 436000,China;Department of Pharmacy,Huangshi Central Hospital of Edong Medical Group,Huangshi 435000,China)

机构地区：[1]湖北省鄂州市中心医院药学部,436000 [2]鄂东医疗集团黄石市中心医院药学部,湖北省黄石市435000

出　　处：《实用心脑肺血管病杂志》2018年第2期63-67,共5页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

摘　　要：目的采用药物经济学循证方法比较比阿培南、美罗培南和亚胺培南/西司他丁治疗呼吸系统和/或泌尿系统细菌感染的成本-效果。方法计算机检索中国知网(CNKI)、维普中文期刊全文数据库(VIP)、万方数据知识服务平台,并手动检索相关杂志、会议论文及学术论文,检索比阿培南、美罗培南、亚胺培南/西司他丁治疗呼吸系统和/或泌尿系统细菌感染的相关文献,检索时间2000—2017年。评价3种碳青霉烯类抗菌药物治疗14 d的临床疗效和细菌清除效果,计算成本-效果比(C/E)和增量成本-效果比(ΔC/ΔE),并观察不良反应发生情况。结果共纳入13篇文献,包括1 574例呼吸系统和/或泌尿系统细菌感染患者,10个生产厂家。根据治疗方案及药物生产厂家将所有患者分为A组326例、B组72例、C组59例、D组132例、E组415例、F组114例、G组213例、H组153例、I组40例、J组50例。H组患者临床疗效和细菌清除效果的C/E均为最小,以H组作为对照计算ΔC/ΔE,结果显示,C组、E组、F组、I组和J组患者临床疗效的ΔC/ΔE为负值;A组、B组、D组和G组患者临床疗效的ΔC/ΔE为正值,且4组患者临床疗效的ΔC/ΔE>C/E(H组)。B组、C组、E组、F组、G组、I组和J组患者细菌清除效果的ΔC/ΔE为负值;A组、D组患者细菌清除效果的ΔC/ΔE为正值,且两组患者细菌清除效果的ΔC/ΔE>C/E(H组)。本研究假设药品费用下降15%,其他费用不变,进行敏感性分析,结果与成本-效果分析一致。13篇文献均报道了药物相关不良反应,10组患者不良反应发生率比较,差异无统计学意义(P>0.05)。结论基于现有文献证据,美罗培南(浙江海正药业股份有限公司生产)0.5 g/次、1次/8~12 h是治疗呼吸系统和/或泌尿系统细菌感染的最优治疗方案。Objective To compare the cost-effectiveness of biapenem,meropenem,imipenem/cilastatin in treating respiratory and/or urinary bacterial infection through evidence-based approach pharmacoeconomic evaluation.Methods CNKI,VIP and Wanfang Data Knowledge Service Platform were searched by computer,and related journals,conference papers and academic papers were manually searched to collect pertinent literatures about biapenem,meropenem,imipenem/cilastatin in treating respiratory and/or urinary bacterial infection from 2000 to 2017.Clinical effect and bacterial clearance effect of the three kinds of common carbapenem drugs were evaluated,cost-effectiveness ratio(C/E)and incremental cost-effectiveness ratio(ΔC/ΔE)were calculated,and incidence of adverse reactions was observed.Results A total of 13 literatures were involved,including 1 574 patients with respiratory and/or urinary bacterial infection and 10 drug manufacturers.According to therapeutic regimen and drug manufacturer,all of the 1 574 patients were divided into A group(n=326),B group(n=72),C group(n=59),D group(n=132),E group(n=415),F group(n=114),G group(n=213),H group(n=153),I group(n=40)and J group(n=50).C/E of clinical effect and bacterial clearance effect in H group were both the least,thus we take H group as control and found that,ΔC/ΔE of clinical effect in C group,E group,F group,I group and J group was negative,respectively,whileΔC/ΔE of clinical effect in A group,B group,D group and G group was positive and higher than C/E in H group,respectively;ΔC/ΔE of bacterial clearance effect in B group,C group,E group,F group,G group,I group and J group was negative,respectively,whileΔC/ΔE of bacterial clearance effect in A group and D group was positive and higher than C/E in H group,respectively.We assume that cost of medicine decreased by 15%and other costs stayed the same,the sensitivity analysis results were consistent with the costeffectiveness analysis results.All of the 13 literatures reported drugs related adverse reactions,but no statistically

关 键 词：细菌感染 比阿培南 美罗培南 亚胺培南西司他丁 循证医学 经济学 药物 

分 类 号：R515[医药卫生—内科学]