Thornton J, Elliott R A, Tully M P, Dodd M, Webb A K
School of Pharmacy and Pharmaceutical Sciences, University of Manchester M13 9PL, UK.
J Cyst Fibros. 2005 Dec;4(4):239-47. doi: 10.1016/j.jcf.2005.08.003. Epub 2005 Oct 19.
A cost-effectiveness evaluation comparing home-based and hospital-based treatment with intravenous antibiotics for respiratory exacerbations in adults with cystic fibrosis (CF) has not been previously undertaken.
The study was conducted in a UK adult CF centre from a health service perspective. Clinical outcome and resource use data were obtained from a retrospective one-year study and combined with unit cost data in an incremental economic analysis. The primary outcome measure was percentage change in FEV(1); "effectiveness" was defined as maintenance of baseline average FEV(1) over the one-year study period.
116 patients received 454 courses of intravenous antibiotics. At the end of 1 year, there had been a mean percentage decline in FEV(1) compared with baseline average for home-treated patients but an improvement for hospital-treated patients (Tukey's HSD mean difference 10.1%, 95% CI 2.9 to 17.2, p = 0.003). Treatment was deemed "effective" in more hospital (58.8%) than home (42.6%) patients. The cost of hospital treatment was higher than home treatment (mean difference 9,005 pounds, 95% CI 3,507 to 14,700, p<0.001). The mean ICER was 46,098 pounds (2.5th and 97.5th percentiles -374,044 and 362,472).
Hospital treatment was more effective but more expensive than home treatment. Potential methods to improve outcome at home should be considered but these may have resource implications.
此前尚未对成年囊性纤维化（CF）患者因呼吸道疾病加重采用家庭静脉抗生素治疗和医院静脉抗生素治疗进行成本效益评估。
本研究从卫生服务角度在英国一家成人CF中心开展。临床结局和资源使用数据来自一项为期一年的回顾性研究，并在增量经济分析中与单位成本数据相结合。主要结局指标是第一秒用力呼气容积（FEV₁）的百分比变化；“有效性”定义为在为期一年的研究期间维持基线平均FEV₁。
116例患者接受了454个疗程的静脉抗生素治疗。1年后，与基线平均值相比，家庭治疗患者的FEV₁平均百分比下降，但医院治疗患者有所改善（Tukey's HSD平均差异10.1%，95%CI 2.9至17.2，p = 0.003）。认为治疗“有效”的医院患者（58.8%）多于家庭患者（42.6%）。医院治疗的成本高于家庭治疗（平均差异9005英镑，95%CI 3507至14700，p<0.001）。平均增量成本效果比为46098英镑（第2.5和第97.5百分位数为-374044和362472）。
医院治疗比家庭治疗更有效，但成本更高。应考虑在家中改善结局的潜在方法，但这些方法可能会对资源产生影响。
