McCombs J S, Nichol M B
School of Pharmacy, University of Southern California, Los Angeles, USA.
Pharmacoeconomics. 1995 Jun;7(6):543-54. doi: 10.2165/00019053-199507060-00008.
The Saskatchewan Drug Plan proposed de-listing several second-line antibiotics from its formulary for reasons of potential overuse and expense. This study evaluated the use of second-line antibiotics as initial and secondary courses of therapy depending on the patient's prior use of other antibiotics and other factors. A total of 637,607 courses of therapy dispensed to Plan members for selected antibiotics between July 1989 and June 1990 were evaluated. Second-line antibiotics were used in 5.0% of all initial courses of therapy. This use was correlated with patient characteristics that may warrant use of second-line antibiotics as initial therapy: age, rural residence, the use of bronchodilators or inhaled steroids, and the number of prior courses of antibiotic therapy. The potential savings from de-listing second-line antibiotics from the formulary are limited because of their use in only 5% of all initial courses of therapy. Savings would be further reduced by administrative costs and physician time required to process prior authorisation requests, and the costs of treating any additional antibiotic treatment failures that may result from reduced access.
萨斯喀彻温省药品计划提议将几种二线抗生素从其药品目录中删除，原因是存在潜在的过度使用和费用问题。本研究根据患者先前使用其他抗生素的情况及其他因素，评估了二线抗生素作为初始和二线治疗疗程的使用情况。对1989年7月至1990年6月期间为计划成员配发的选定抗生素的637,607个治疗疗程进行了评估。在所有初始治疗疗程中，5.0%使用了二线抗生素。这种使用情况与可能需要将二线抗生素作为初始治疗的患者特征相关：年龄、农村居住情况、使用支气管扩张剂或吸入性类固醇，以及先前抗生素治疗疗程的数量。由于二线抗生素仅在所有初始治疗疗程的5%中使用，因此从药品目录中删除二线抗生素的潜在节省有限。处理事先授权申请所需的行政成本和医生时间，以及因获取减少可能导致的任何额外抗生素治疗失败的治疗成本，将进一步减少节省金额。
