碳青霉烯类的微型卫生技术评估  

Assessment of carbapenems by Mini health technology assessment

作　　者：梁乔芳 姚欣凯 廖小林 苏桂玉 李祥 LIANG Qiao-fang;YAO Xin-kai;LIAO Xiao-lin;SU Gui-yu;LI Xiang(Department of Pharmacy,the 4th Affiliated Hospital of Guangxi Medical University/Liuzhou Worker’s Hospital,Liuzhou Guangxi 545008;Liuzhou Hospital of Traditional Chinese Medicine(Liuzhou Hospital of Zhuang Medicine),Liuzhou Guangxi 545000;Beihai People’s Hospital,Beihai Guangxi 536000;Qinhuai Medical Division,General Hospital of the Easter Theaer,Nanjing 210002)

机构地区：[1]广西医科大学第四附属医院/柳州市工人医院药学部,广西柳州545008 [2]柳州市中医医院/柳州市壮医医院,广西柳州545000 [3]北海市人民医院,广西北海536000 [4]东部战区总医院秦淮医疗区,南京210002

出　　处：《中南药学》2023年第7期1954-1962,共9页Central South Pharmacy

基　　金：广西壮族自治区卫生健康委员会自筹经费课题(No.Z20200474)。

摘　　要：目的对碳青霉烯类药品进行微型卫生技术评估(Mini-HTA),为医院决策者遴选、临床合理使用提供依据。方法通过查阅指南、文献、说明书等,药师与医师共同构建百分制评分系统,从临床安全性、有效性、经济性、创新性、可及性共5个大方面分别对碳青霉烯类进行Mini-HTA,并对分值权重进行评分。结果美罗培南、亚胺培南/西司他丁及比阿培南得分分别为75分、74分及71.5分。三者用于治疗产ESBL重症感染患者具有较好的疗效,肝功能不全患者不需调整剂量、安全性佳。三者均为医保目录收录品种,跟其他药物均存在相互作用,且与抗癫痫药存在配伍禁忌。但三者有一定差异,比阿培南和亚胺培南/西司他丁的价格偏高但其生产企业信誉度良好,且在全球范围内广泛使用;美罗培南虽然企业信誉度稍逊,但价格便宜;亚胺培南/西司他丁为原研药品,美罗培南和比阿培南为仿制药品。亚胺培南/西司他丁和美罗培南均可用于儿童和妊娠妇女,比阿培南除外。亚胺培南/西司他丁常温下保存即可,美罗培南和比阿培南需要避光保存。亚胺培南/西司他丁和美罗培南保质期均为两年,比阿培南的保质期稍短,仅18个月。结论在当前医疗“零加成”政策及倡导价值医疗的形势下,本次对三种碳青霉烯类进行Mini-HTA,医院决策者可结合自身医疗情况,合理遴选及使用该类药品。Objective To provide reference for hospital decision-makers to select carbapenems by Mini health technology assessment(Mini-HTA).Methods Full score system was established through reviewing guidelines,literatures and instructions.From the aspects of clinical safety,effectiveness,economy,innovation and accessibility,the Mini-HTA was conducted for carbapenems,and scored on the basis of weight value.Results The final scores of meropenem,imipenem/cilastatin and biapenem were 75,74 and 71.5 respectively.For ESBL patients with severe infection,all three drugs had good curative effect,and could be safely used in patients with liver dysfunction without dose adjustment.Included in the medical insurance list,they might interact with other drugs,and were incompatible with antiepileptic drugs.Biapenem and imipenem/cilastatin were somewhat expensive,but their manufacturers had a good reputation and they were widely used in the world.Meropenem was less reputable but cheaper.Imipenem/cilastatin was original varieties,while meropenem and biapenem were generic drugs.Imipenem/cilastatin and meropenem could be used in children and pregnant women,but not biapenem.Imipenem/cilastatin could be stored at room temperature,while meropenem and biapenem should be kept away from light.The shelf life of imipenem/cilastatin and meropenem was two years,and that of biapenem was 18 months.Conclusion Under the current medical policy,Mini-HTA helps decision-makers of the hospital to reasonably select the three carbapenems.

关 键 词：微型卫生技术评估 药品遴选 亚胺培南/西司他丁 美罗培南 比阿培南 

分 类 号：R977.6[医药卫生—药品]