Simoens Steven, Decramer Marc, Laekeman Gert
Research Centre for Pharmaceutical Care and Pharmaco-economics, Faculty of Pharmaceutical Sciences, KU Leuven, Onderwijs en Navorsing 2, Herestraat 49, 3000 Leuven, Belgium.
Respir Med. 2007 Jan;101(1):15-26. doi: 10.1016/j.rmed.2006.03.030. Epub 2006 May 2.
This article synthesizes and appraises the methodological quality of the international literature on costs of chronic obstructive pulmonary disease (COPD) exacerbations, economic value of antimicrobial therapy of exacerbations, and factors affecting the economic value of antibiotics. Included studies had carried out a cost-of-illness, cost-effectiveness, cost-utility or cost-benefit analysis. Exacerbation costs varied between countries and increased with the severity of the exacerbation. Hospitalization costs accounted for more than 45% of healthcare costs of exacerbations. Drug costs made up 6-21% of healthcare costs in the majority of studies. Cost estimates were biased due to difficulties involved in diagnosing and treating exacerbations, and because the patient sample studied may not be representative of the population of patients suffering from exacerbations. Although this needs to be corroborated by future research, evidence is emerging that second-generation antibiotics such as fluoroquinolones may have a favourable economic profile as compared with first-generation antibiotics. The higher acquisition costs of fluoroquinolones appear to be balanced by less treatment failure, more time between exacerbation episodes, and lower hospitalization costs. There is a need for prospective economic evaluations alongside clinical trials with a sufficient number of patients and length of follow-up period. The economic value of antibiotics is influenced by difficulties involved in diagnosing the condition, effectiveness, resistance, patient compliance with treatment, and treatment failure associated with antibiotics. The small number of economic evaluations and their methodological limitations precludes the recommendation of a specific antibiotic for use in the management of COPD exacerbations on economic grounds.
本文综合并评估了关于慢性阻塞性肺疾病（COPD）急性加重期成本、急性加重期抗菌治疗的经济价值以及影响抗生素经济价值的因素的国际文献的方法学质量。纳入的研究进行了疾病成本、成本效益、成本效用或成本效益分析。各国之间急性加重期成本有所不同，且随急性加重的严重程度增加而上升。住院成本占急性加重期医疗保健成本的45%以上。在大多数研究中，药物成本占医疗保健成本的6 - 21%。由于诊断和治疗急性加重期存在困难，且所研究的患者样本可能不代表患有急性加重期的患者群体，成本估计存在偏差。尽管这需要未来的研究加以证实，但有证据表明，与第一代抗生素相比，氟喹诺酮类等第二代抗生素可能具有较好的经济状况。氟喹诺酮类较高的购置成本似乎被较少的治疗失败、急性加重发作之间更长的时间间隔以及更低的住院成本所平衡。需要在有足够数量患者和随访期长度的临床试验的同时进行前瞻性经济评估。抗生素的经济价值受到疾病诊断困难、有效性、耐药性、患者对治疗的依从性以及与抗生素相关的治疗失败等因素的影响。由于经济评估数量较少及其方法学局限性，无法基于经济理由推荐一种特定的抗生素用于COPD急性加重期的管理。
