Bucaneve G, Menichetti F, Del Favero A
Istituto di Medicina Interna e Scienze Oncologiche, Policlinico Monteluce, Perugia, Italy.
Pharmacoeconomics. 1999 Jan;15(1):85-95. doi: 10.2165/00019053-199915010-00006.
Patients with cancer-associated neutropenia are at high risk of developing severe infections which can be fatal if treatment is not promptly administered. For this reason, fever is treated as soon as possible with broad spectrum antibacterial therapy. The objective of this study was to conduct a cost analysis in Italy comparing 2 empiric glycoprotein-containing antibacterial regimens for the treatment of febrile neutropenia in patients with acute leukaemia.
A retrospective cost analysis was conducted, using the records of 527 febrile neutropenic patients with acute leukaemia who participated in an 18-month multicentre (29 Italian haematological units) randomised trial during 1991. All patients received either of the following 2 empiric intravenous regimens, each containing 3 antibacterial agents: ceftazidime (2 g, 3 times daily) and amikacin (15 mg/kg/day, in 3 separate doses) plus teicoplanin (6 mg/kg, in a single dose) or vancomycin (30 mg/kg/day, in 2 separate doses). Economic analyses were carried out from a hospital perspective. Only the direct costs per patient, i.e. mean antibacterial treatment and management cost, mean overall treatment failure cost and mean cost of adverse effects, were included.
No differences were found in the clinical response, defined as the improvement in the rate of fever or infection (if documented), between the 2 regimens. However, tolerability, defined as the incidence of adverse effects probably or definitely related to the assigned treatment, was reported to be better with the teicoplanin-rather than the vancomycin-containing regimen.
Thus retrospective cost analysis showed that despite the higher acquisition cost of teicoplanin relative to vancomycin, the lower incidence of adverse effects associated with teicoplanin and its ease of administration (single daily dose) resulted in equivalent overall treatment costs between teicoplanin- and vancomycin containing regimens.
癌症相关性中性粒细胞减少症患者发生严重感染的风险很高，如果不及时治疗可能会致命。因此，一旦出现发热，应尽快采用广谱抗菌治疗。本研究的目的是在意大利进行一项成本分析，比较两种含糖蛋白的经验性抗菌方案治疗急性白血病患者发热性中性粒细胞减少症的效果。
进行了一项回顾性成本分析，使用了1991年期间参与一项为期18个月的多中心（29个意大利血液科单位）随机试验的527例急性白血病发热性中性粒细胞减少症患者的记录。所有患者接受以下两种经验性静脉用药方案中的一种，每种方案包含3种抗菌药物：头孢他啶（2克，每日3次）和阿米卡星（15毫克/千克/天，分3次给药）加替考拉宁（6毫克/千克，单次给药）或万古霉素（30毫克/千克/天，分2次给药）。经济分析是从医院的角度进行的。仅包括每位患者的直接成本，即平均抗菌治疗和管理成本、平均总体治疗失败成本以及平均不良反应成本。
两种方案在临床反应方面没有差异，临床反应定义为发热或感染率（如有记录）的改善情况。然而，据报道，以替考拉宁为基础的方案在耐受性方面更好，耐受性定义为可能或肯定与指定治疗相关的不良反应发生率。
因此，回顾性成本分析表明，尽管替考拉宁的采购成本高于万古霉素，但与替考拉宁相关的不良反应发生率较低且给药方便（每日单次剂量），使得含替考拉宁方案和含万古霉素方案的总体治疗成本相当。
