Laurier C, Lachaine J, Ducharme M
Faculty of Pharmacy, Université de Montréal, Québec, Canada. lauriercere.umontreal.ca
Pharmacoeconomics. 1999 Jan;15(1):97-113. doi: 10.2165/00019053-199915010-00007.
The objective of this study was to compare costs, efficacy and cost efficacy of alternate oral antibacterial regimens for the ambulatory treatment of acute sinusitis. A public third-party perspective was adopted.
The analysis was based on a decision tree and considered the episode of care from the decision to initiate an antibacterial until the end of the first course of treatment or the end of a subsequent course of treatment when needed. Efficacy data were retrieved from published clinical trials. Direct medical costs included the costs of physician visits, diagnostic tests and medications.
The study pertained to adults treated in a primary-care setting in the Canadian province of Québec.
The antibacterials studied were amoxicillin, amoxicillin/clavulanate, azithromycin, cefaclor, cefuroxime axetil and clarithromycin.
The main outcome measured was the proportion of patients showing resolution or improvement of their symptoms. Initiating a treatment with amoxicillin was associated with similar efficacy and lower overall costs when compared with the other antibacterials. Low dosages of clarithromycin and azithromycin followed amoxicillin in terms of cost-efficacy ratio.
This study confirms the place of amoxicillin as a first choice agent for acute sinusitis, with low dose clarithromycin and azithromycin as second choices.
本研究旨在比较用于门诊治疗急性鼻窦炎的不同口服抗菌治疗方案的成本、疗效及成本效益。采用公共第三方视角。
该分析基于决策树，考虑了从决定开始使用抗菌药物直至首个疗程结束或必要时后续疗程结束的整个治疗过程。疗效数据取自已发表的临床试验。直接医疗成本包括就诊、诊断检查及药物费用。
该研究针对加拿大魁北克省初级保健机构中接受治疗的成年人。
所研究的抗菌药物有阿莫西林、阿莫西林/克拉维酸、阿奇霉素、头孢克洛、头孢呋辛酯和克拉霉素。
主要测量的结局是症状缓解或改善的患者比例。与其他抗菌药物相比，起始使用阿莫西林具有相似的疗效且总体成本更低。就成本效益比而言，低剂量克拉霉素和阿奇霉素仅次于阿莫西林。
本研究证实阿莫西林作为急性鼻窦炎的首选药物地位，低剂量克拉霉素和阿奇霉素为次选。
