基于真实世界的治疗耐碳青霉烯病原菌抗菌药物方案的药物经济学评价  

Pharmacoeconomic Evaluation of Antimicrobial Treament for Carbapenem-resistant Organism according to Real World Data

作　　者：辛雅雯 卓玛层 师永兰 赵元晶 李清 刘金玲 张明霞 王亚峰[1] XIN Ya-Wen;ZHUO Ma-Ceng;SHI Yong-Lan;ZHAO Yuan-Jing;LI Qing;LIU Jin-Ling;ZHANG Ming-Xia;WANG Ya-Feng(Department of Pharmacy,Qinghai Provincial People’s Hospital,Xining 810000,China)

机构地区：[1]青海省人民医院药学部,西宁810000

出　　处：《中国药物经济学》2024年第3期5-10,共6页China Journal of Pharmaceutical Economics

摘　　要：目的从卫生系统角度评价美罗培南与替加环素联合美罗培南治疗碳青霉烯类耐药细菌(CRO)的经济性。方法以2016年6月至2020年7月于青海省人民医院确诊为CRO感染,且使用抗菌药物为美罗培南或替加环素联合美罗培南的住院患者为研究对象,根据其抗感染方案分为美罗培南(倍能)(A组)38例、美罗培南(美平)(B组)7例、替加环素(天解)联合美罗培南组(C组)10例、替加环素(泰阁)联合美罗培南组(D组)28例。根据患者临床资料获取效果、效用和成本等参数信息,建立周期为14d的决策树模型评价4种治疗方案的经济性。结果A、B、C和D组的期望成本分别为13850.34、13547.43、16233.60和25495.72元;4组有效率分别是87.50%、42.90%、81.80%和88.50%,B组有效率较其他3组低,差异有统计学意义(P<0.05);4组细菌清除率分别是45.00%、14.30%、18.20%和57.70%,B组、C组细菌清除率均低于其他两组,但差异无统计学意义(P>0.05)。各组的质量调整生命年(QALYs)值分别为6.755×10^(-3)年、9.917×10^(-3)年、9.496×10^(-3)年和5.504×10^(-3)年。增量成本-效果分析显示,A组为参照方案,其他3组不具有经济性;增量成本-效用分析显示,A组为参照方案,B组有绝对优势,C组和D组不具有经济性。结论对于CRO感染患者的抗菌药物治疗方案中,以美罗培南为基础的抗菌药物方案更具经济学优势。Objective To evaluate the economic of meropenmen versus tigecycline(combined with meropenem)for the treatment of carbapenem resistant organism(CRO)from the health system perspective.Methods The subjects were hospitalized patients diagnosed with CRO infection in Qinghai Provincial People's Hospital from June 2016 to July 2020 who were treated with meropenem or tigecycline combined with meropenem as antimicrobials.According to its anti-infection regimen,the patients were divided into meropenem(Beconol)(group A)in 38 cases,meropenem(Mepein)(group B)in 7 cases,Tigecycline(Tiantil)combined with meropenem(group C)in 10 cases,and Tigecycline(Tague)combined with meropenem(group D)in 28 cases.A 14-day decision tree model was established to evaluate the economy of the four treatment schemes according to the clinical data of patients.Results The expected costs of group A,B,C and D were 13850.34 yuan,13547.43 yuan,16233.60 yuan and 25495.72 yuan,respectively.The effective rates of the four groups were 87.50%,42.90%,81.80%and 88.50%,respectively.The effective rate of group B was lower than that of the other three groups,and there was a significant different in the effective rate(P<0.05).The bacterial clearance rates of the four groups were 45.00%,14.30%,18.20%and 57.70%,respectively.The clearance rate of group B and group C was lower than the other two groups,and there was no significant difference in the clearance rates(P>0.05).The QALYs of each group were 6.755×10^(-3)、9.917×10^(-3)、9.496×10^(-3)和5.504×10^(-3),respectively.The incremental cost-effectiveness ratio(ICER)shows,A group has economic advantage versus the other three groups.The incremental cost-utility ratio(ICUR)shows,B group was the absolute dominant regimen.Conclusion Meropenem has economic advantage versus in the antimicrobial treatment of CRO.

关 键 词：耐碳青霉烯类 革兰阴性菌 经济学评价 增量成本-效果比 增量成本-效用比 

分 类 号：R978.1[医药卫生—药品] R956[医药卫生—药学]