Paladino Joseph A, Gudgel Larry D, Forrest Alan, Niederman Michael S
CPL Associates LLC, State University of New York at Buffalo, Buffalo, NY, USA.
Chest. 2002 Oct;122(4):1271-9. doi: 10.1378/chest.122.4.1271.
To conduct a cost-effectiveness analysis of IV-to-oral regimens of azithromycin vs cefuroxime with or without erythromycin in the treatment of patients hospitalized with community-acquired pneumonia (CAP).
Of the 268 evaluable patients enrolled into a randomized, multicenter clinical trial of adults, 266 patients had sufficient data to be included in this cost-effectiveness analysis. One hundred thirty-six patients received azithromycin, and 130 patients received cefuroxime with or without erythromycin.
A pharmacoeconomic analysis from the hospital provider perspective was conducted. Health-care resource utilization was extracted from the clinical database and converted to national reference costs. Decision analysis was used to structure and characterize outcomes. Sensitivity analyses were performed, and statistics were applied to the cost-effectiveness ratios.
The clinical success and adverse event rates and antibiotic-related length of stay were 78%, 11.8%, and 5.8 days for the azithromycin group and 75%, 20.7%, and 6.4 days for the group receiving cefuroxime with or without erythromycin, respectively. Geometric mean treatment costs were 4,104 US dollars (95% confidence interval [CI], 3,874 to 4,334 US dollars) for the azithromycin group, and 4,578 US dollars (95% CI, 4,319 to 4,837 US dollars) for the group receiving cefuroxime with or without erythromycin (p = 0.06). The cost-effectiveness ratios were 5,265 US dollars per expected cure for the azithromycin group, and 6,145 US dollars per expected cure for group receiving cefuroxime with or without erythromycin (p = 0.05).
Despite a higher per-dose purchase price, overall costs with azithromycin tended to be lower due to decreased duration of therapy, lower preparation and administration costs, and reduced hospital length of stay. As empiric therapy, azithromycin monotherapy was cost-effective compared to cefuroxime with or without erythromycin for patients hospitalized with CAP who have no underlying cardiopulmonary disease, and no risk factors for either drug-resistant pneumococci or enteric Gram-negative pathogens.
对阿奇霉素静脉给药序贯口服方案与头孢呋辛联合或不联合红霉素治疗社区获得性肺炎（CAP）住院患者进行成本效益分析。
在一项纳入268例可评估患者的成人随机多中心临床试验中，266例患者有足够数据纳入本成本效益分析。136例患者接受阿奇霉素治疗，130例患者接受头孢呋辛联合或不联合红霉素治疗。
从医院提供者角度进行药物经济学分析。从临床数据库中提取医疗资源利用情况，并转换为国家参考成本。采用决策分析构建和描述结果。进行敏感性分析，并将统计学方法应用于成本效益比。
阿奇霉素组的临床成功率、不良事件发生率和抗生素相关住院时间分别为78%、11.8%和5.8天，接受头孢呋辛联合或不联合红霉素治疗的组分别为75%、20.7%和6.4天。阿奇霉素组的几何平均治疗成本为4104美元（95%置信区间[CI]，3874至4334美元），接受头孢呋辛联合或不联合红霉素治疗的组为4578美元（95%CI，4319至4837美元）（p = 0.06）。阿奇霉素组的成本效益比为每预期治愈1例5265美元，接受头孢呋辛联合或不联合红霉素治疗的组为每预期治愈1例6145美元（p = 0.05）。
尽管阿奇霉素每剂购买价格较高，但由于治疗时间缩短、制剂和给药成本降低以及住院时间缩短，其总体成本往往较低。作为经验性治疗，对于无基础心肺疾病、无耐药肺炎球菌或肠道革兰阴性病原体危险因素的CAP住院患者，阿奇霉素单药治疗与头孢呋辛联合或不联合红霉素相比具有成本效益。
