Skrepnek Grant H, Armstrong Edward P, Malone Daniel C, Ramachandran Sulabha
Center for Health Outcomes and PharmacoEconomic Research, University of Arizona, College of Pharmacy, Tucson, AZ 85721, USA.
Curr Med Res Opin. 2005 Feb;21(2):261-70. doi: 10.1185/030079904X26207.
To evaluate the resource consumption and outcomes associated with first-line monotherapy for community-acquired pneumonia, focusing specifically on the use of erythromycin, azithromycin, clarithromycin, and levofloxacin.
Retrospective managed care database analysis.
Subjects included patients within a managed care setting over 18 years of age with an initial diagnosis of community-acquired pneumonia from January 1995 to April 2002. Multivariate linear and logistic regression models were used to examine associations with treatment success rates and direct medical costs between antibiotic treatments after controlling for patient demographics and pneumonia risk factors.
Overall, treatment success rates were high (95.8%), the use of second antibiotics was un common (2.3%), and hospitalizations were infrequent (2.0%) among the 1952 subjects studied. After controlling for patient characteristics and risk factors, significantly lower total costs were associated with erythromycin (92.7% lower, p < 0.001), azithromycin (48.7% lower, p < 0.001), and clarithromycin (21.3% lower, p = 0.015) relative to levofloxacin, with no difference in treatment success between groups. Among newer agents, azithromycin (49.2% lower, p < 0.001) and clarithromycin (21.7% lower, p = 0.013) treatment groups were associated with significantly lower total costs than levofloxacin in the full sample. However, in subjects with a chronic disease score above the sample's mean, only azithromycin was associated with significantly lower total costs (47.9% lower, p < 0.001) relative to levofloxacin.
Erythromycin, azithromycin, and clarithromycin were associated with significantly lower total costs than levofloxacin, although treatment success rates did not differ between groups. Following stratification based upon various subset criteria, erythromycin and azithromycin were observed to have significantly lower total costs than levofloxacin. Although these findings may augment clinical guidelines and evidence-based approaches, health plans should consider evaluating their own patient data to see if similar differences exist in their populations.
评估社区获得性肺炎一线单药治疗的资源消耗及相关结局，尤其关注红霉素、阿奇霉素、克拉霉素和左氧氟沙星的使用情况。
回顾性管理式医疗数据库分析。
研究对象包括1995年1月至2002年4月在管理式医疗环境中初次诊断为社区获得性肺炎的18岁以上患者。在控制患者人口统计学特征和肺炎危险因素后，使用多变量线性和逻辑回归模型来检验抗生素治疗与治疗成功率和直接医疗费用之间的关联。
总体而言，在1952名研究对象中，治疗成功率较高（95.8%），使用第二种抗生素的情况不常见（2.3%），住院率较低（2.0%）。在控制患者特征和危险因素后，相对于左氧氟沙星，红霉素（降低92.7%，p<0.001）、阿奇霉素（降低48.7%，p<0.001）和克拉霉素（降低21.3%，p = 0.015）的总费用显著更低，各组间治疗成功率无差异。在所有样本中，在新型药物中，阿奇霉素（降低49.2%，p<0.001）和克拉霉素（降低21.7%，p = 0.013）治疗组的总费用显著低于左氧氟沙星。然而，在慢性病评分高于样本均值的患者中，相对于左氧氟沙星，只有阿奇霉素的总费用显著更低（降低47.9%><0.001）。
尽管各组间治疗成功率无差异，但红霉素、阿奇霉素和克拉霉素的总费用显著低于左氧氟沙星。根据各种亚组标准分层后，观察到红霉素和阿奇霉素的总费用显著低于左氧氟沙星。尽管这些发现可能会完善临床指南和循证方法，但健康计划应考虑评估自身患者数据，以查看其人群中是否存在类似差异。
