Walters D J, Solomkin J S, Paladino J A
Clinical Pharmacokinetics Laboratory, Millard Fillmore Suburban Hospital, Buffalo, New York, USA.
Pharmacoeconomics. 1999 Nov;16(5 Pt 2):551-61. doi: 10.2165/00019053-199916050-00011.
To compare the cost effectiveness of sequential intravenous (i.v.) to oral ciprofloxacin plus metronidazole (CIP/MTZ i.v./PO) with that of i.v. ciprofloxacin plus i.v. metronidazole (CIP/MTZ i.v.) and i.v. imipenem-cilastatin (IMI i.v.) in patients with intra-abdominal infections.
Patients enrolled in a double-blind randomised clinical trial were eligible for inclusion into this cost-effectiveness analysis. Decision analysis was used to characterise the economic outcomes between groups and provide a structure upon which to base the sensitivity analyses. 1996 cost values were used throughout.
The economic perspective of the analysis was that of a hospital provider.
Among 446 economically evaluable patients, 176 could be switched from i.v. to oral administration. The 51 patients randomised to CIP/MTZ i.v./PO who received active oral therapy had a success rate of 98%, mean duration of therapy of 9.1 days and mean cost of $US7678. There were 125 patients randomized to either CIP/MTZ i.v. or IMI i.v. who received oral placebo while continuing on active i.v. antibacterials; their success rate was 94%, mean duration of therapy was 10.1 days and mean cost was $US8774 (p = 0.029 vs CIP/MTZ i.v./PO). Of the 270 patients who were unable to receive oral administration, 97 received IMI i.v. and had a success rate of 75%, mean duration of therapy of 13.8 days and a mean cost of $US12,418, and 173 received CIP/MTZ i.v. and had a success rate of 77%, mean duration of therapy of 13.4 days and mean cost of $US12,219 (p = 0.26 vs IMI i.v.).
In patients able to receive oral therapy, sequential i.v. to oral treatment with ciprofloxacin plus metronidazole was cost effective compared with full i.v. courses of ciprofloxacin plus metronidazole or imipenem-cilastatin. In patients unable to receive oral therapy, no difference in mean cost was found between i.v. imipenem-cilastatin or i.v. ciprofloxacin plus i.v. metronidazole.
比较环丙沙星联合甲硝唑序贯静脉给药继以口服给药（CIP/MTZ i.v./PO）、环丙沙星联合甲硝唑静脉给药（CIP/MTZ i.v.）以及亚胺培南 - 西司他丁静脉给药（IMI i.v.）治疗腹腔内感染患者的成本效益。
纳入一项双盲随机临床试验的患者符合纳入本成本效益分析的条件。采用决策分析来描述组间的经济结局，并提供进行敏感性分析的基础结构。全程使用1996年的成本值。
分析的经济学视角是医院提供者。
在446例可进行经济学评估的患者中，176例可从静脉给药转为口服给药。随机接受CIP/MTZ i.v./PO且接受活性口服治疗的51例患者成功率为98%，平均治疗时长为9.1天，平均成本为7678美元。有125例随机接受CIP/MTZ i.v.或IMI i.v.的患者在继续接受活性静脉抗菌药物治疗的同时接受口服安慰剂；他们的成功率为94%，平均治疗时长为10.1天，平均成本为8774美元（与CIP/MTZ i.v./PO相比，p = 0.029）。在270例无法接受口服给药的患者中，97例接受IMI i.v.，成功率为75%，平均治疗时长为13.8天，平均成本为12418美元，173例接受CIP/MTZ i.v.，成功率为77%，平均治疗时长为13.4天，平均成本为12219美元（与IMI i.v.相比，p = 0.26）。
对于能够接受口服治疗的患者，环丙沙星联合甲硝唑序贯静脉给药继以口服治疗与环丙沙星联合甲硝唑或亚胺培南 - 西司他丁全程静脉给药相比具有成本效益。对于无法接受口服治疗的患者，亚胺培南 - 西司他丁静脉给药与环丙沙星联合甲硝唑静脉给药的平均成本无差异。
