Portolés A, Palau E, Puerro M, Vargas E, Picazo J J
Servicios Farmacología Clínica, Hospital Clínico San Carlos, Madrid, Spain.
Rev Esp Quimioter. 2006 Mar;19(1):65-75.
The objective of this study, conducted at Hospital Clínico San Carlos, Madrid, Spain, was to compare the cost of treatment of Gram-positive infections with teicoplanin and vancomycin under normal conditions. Using a prospective observational study design for drug utilization and economic assessment, we evaluated the comparability of the sample, adverse events, features of treatment with teicoplanin/vancomycin and factors influencing the consumption of resources until the end of glycopeptide treatment or discharge (whichever occurred later) using Health System perspective. Costs were assigned using the hospital's evaluation at the time of the study. Analyses made: multivariate, sensitivity (by modifying staff or acquisition costs) and simulation of reduction of stay by early discharge in the teicoplanin group. Study participants included 201 patients who had been using teicoplanin (n=100) or vancomycin (n=101) for at least four days. Data collected daily outside morning work timetable. Costs of acquisition, administration and monitoring by course of treatment (mean+/-SD, in euros) were lower in the vancomycin group (teicoplanin euro647.62+/-euro572.75 vs. vancomycin euro378.11+/-euro225.90); when total costs (including hospital stay) were considered, no differences were found (teicoplanin euro4,432.04+/-euro3,383.46 vs. vancomycin euro4,364.44+/-euro2,734.24). Conditions of use and results were similar for both antibiotics. The economic results of acquisition, administration and monitoring were advantageous for vancomycin; when global costs of care were taken into account, these differences were not evident. Tolerability was significantly advantageous in the teicoplanin group (with regard to phlebitis and elevation of creatininemia), without differences in clinical or economic outcomes. The formulation of teicoplanin did not take advantage of its potential benefits of administration.
这项在西班牙马德里的圣卡洛斯临床医院开展的研究，旨在比较在正常情况下使用替考拉宁和万古霉素治疗革兰氏阳性菌感染的成本。采用前瞻性观察性研究设计进行药物利用和经济评估，我们从卫生系统角度评估了样本的可比性、不良事件、替考拉宁/万古霉素治疗的特点以及影响资源消耗的因素，直至糖肽类药物治疗结束或出院（以较晚者为准）。成本按照研究时医院的评估进行分配。进行了多变量分析、敏感性分析（通过修改人员或采购成本）以及替考拉宁组提前出院缩短住院时间的模拟分析。研究参与者包括201例使用替考拉宁（n = 100）或万古霉素（n = 101）至少四天的患者。在上午工作时间表之外每日收集数据。万古霉素组每个疗程的采购、给药和监测成本（均值±标准差，单位：欧元）更低（替考拉宁647.62欧元±572.75欧元，万古霉素378.11欧元±225.90欧元）；考虑总成本（包括住院费用）时，未发现差异（替考拉宁4432.04欧元±3383.46欧元，万古霉素4364.44欧元±2734.24欧元）。两种抗生素的使用条件和结果相似。万古霉素在采购、给药和监测的经济结果方面具有优势；考虑到总体护理成本时，这些差异并不明显。替考拉宁组在耐受性方面具有显著优势（在静脉炎和肌酐血症升高方面），临床或经济结果无差异。替考拉宁的剂型未发挥其给药的潜在优势。
