Paladino Joseph A, Adelman Martin H, Schentag Jerome J, Iannini Paul B
CPL Associates, LLC, Amherst, New York 14226-1727, USA.
Pharmacoeconomics. 2007;25(8):677-83. doi: 10.2165/00019053-200725080-00005.
Antibacterial cost-containment programmes emphasise the use of narrow-spectrum generic agents whenever possible. The use of these agents is driven by their lower purchase prices; the consequences of treatment failure are rarely considered. This study was conducted to identify the costs of treating patients hospitalised with community-acquired pneumonia (CAP) associated with Streptococcus pneumoniae following failure to respond to outpatient treatment with macrolide antibacterials.
A multicentre, retrospective, observational study was performed in patients with CAP due to S. pneumoniae who were admitted to 31 North American hospitals following a lack of response to >or=2 days of outpatient treatment with a macrolide antibacterial. Direct medical costs (year 2004 values) of infection-related hospital resources, including antibacterials (purchase, preparation, dispensing, administration and monitoring), diagnostic tests, therapeutic procedures, treatment of adverse events and therapeutic failures, and hospitalisation per diem (ward, critical care and ventilator days), were analysed. Total hospital costs were then compared with standard diagnosis-related group (DRG) reimbursement.
A total of 122 patients were enrolled. Patients were frequently bacteraemic (52%) and infected with macrolide-resistant strains of S. pneumoniae (71%). Initial inpatient antibacterial treatment was not successful in 17 patients (14%) and seven patients (5.7%) died. The mean length of stay was 8.7 days (SD 7) including 1.3 days (SD 2.9) in a critical care unit and 1.4 days (SD 4.4) of mechanical ventilation. The mean cost of hospitalisation was US dollars 12,678 (SD 13 346) but standard DRG reimbursement averaged only US dollars 8,634.
Patients who do not respond to outpatient treatment with a macrolide antibacterial and who are subsequently hospitalised with CAP caused by S. pneumoniae are likely to be infected with a non-susceptible strain, are frequently bacteraemic, are at an increased risk for mortality compared with previously published estimates in patients with CAP due to S. pneumoniae, and incur hospital costs that far exceed standard DRG reimbursement for CAP.
抗菌药物成本控制方案强调尽可能使用窄谱非专利药物。使用这些药物是因为其购买价格较低；而治疗失败的后果则很少被考虑。本研究旨在确定门诊使用大环内酯类抗菌药物治疗社区获得性肺炎（CAP）患者失败后，住院治疗肺炎链球菌所致CAP的成本。
对31家北美医院收治的因肺炎链球菌导致CAP且门诊使用大环内酯类抗菌药物治疗≥2天无效的患者进行了一项多中心、回顾性观察研究。分析了感染相关医院资源的直接医疗成本（2004年价值），包括抗菌药物（采购、配制、分发、给药和监测）、诊断检查、治疗程序、不良事件和治疗失败的治疗以及每日住院费用（病房、重症监护和呼吸机使用天数）。然后将总住院费用与标准诊断相关组（DRG）报销费用进行比较。
共纳入122例患者。患者常有菌血症（52%）且感染了对大环内酯耐药的肺炎链球菌菌株（71%）。17例患者（14%）初始住院抗菌治疗未成功，7例患者（5.7%）死亡。平均住院时间为8.7天（标准差7天），其中重症监护病房住院1.3天（标准差2.9天），机械通气1.4天（标准差4.4天）。平均住院费用为12,678美元（标准差13,346美元），但标准DRG报销平均仅为8,634美元。
门诊使用大环内酯类抗菌药物治疗无效且随后因肺炎链球菌导致CAP住院的患者，可能感染了不敏感菌株，常有菌血症，与先前发表的肺炎链球菌所致CAP患者的估计死亡率相比死亡风险增加，且住院费用远远超过CAP的标准DRG报销费用。
