Opmeer B C, El Moussaoui R, Bossuyt P M M, Speelman P, Prins J M, de Borgie C A J M
Academic Medical Centre, Department of Clinical Epidemiology, Biostatistics and Bioinformatics, PO Box 22660, 1100 DD Amsterdam, The Netherlands.
J Antimicrob Chemother. 2007 Nov;60(5):1131-6. doi: 10.1093/jac/dkm313. Epub 2007 Sep 7.
The optimal duration of antibiotic therapy in patients with uncomplicated pneumonia may be shorter than that recommended in the current guidelines. A shorter duration will probably also lead to a cost reduction. This study evaluates the costs associated with 3 versus 8 day antibiotic therapy and subsequent follow-up in patients hospitalized with mild-to-moderate-severe community-acquired pneumonia.
The economic evaluation was based on primary resource utilization data collected within the framework of a randomized, double blind, placebo-controlled trial. As 3 day therapy was shown to be clinically not inferior to 8 day therapy, the cost-minimization analysis was performed based on direct medical and indirect non-medical costs, estimated from a societal perspective for the 28 days following hospital admission.
Lower costs of shorter therapy during hospital admission (euro 209 lower) were partially offset by higher costs for primary healthcare providers (euro 66 higher). The average costs generated per patient by resource utilization during admission and follow-up were estimated as euro 3,959 in the 3 day group versus euro 4,102 in the 8 day group (difference euro 143 in favour of shorter therapy). The difference was affected by changes in assumptions concerning the unit costs for hospital stay but was consistently in favour of shorter therapy.
Shorter duration of antibiotic therapy in hospitalized patients with uncomplicated pneumonia does not result in a substantial substitution of resource utilization to primary healthcare providers. As 3 day antibiotic therapy does not lead to inferior clinical results, these findings support a 3 day therapy as a more efficient strategy.
无并发症肺炎患者抗生素治疗的最佳疗程可能短于现行指南所推荐的疗程。疗程缩短可能还会降低成本。本研究评估了轻度至中度严重社区获得性肺炎住院患者接受3天与8天抗生素治疗及后续随访的相关成本。
经济评估基于在一项随机、双盲、安慰剂对照试验框架内收集的主要资源利用数据。由于3天治疗在临床上并不劣于8天治疗，因此基于直接医疗成本和间接非医疗成本进行成本最小化分析，这些成本从社会角度对入院后28天进行估算。
住院期间较短疗程治疗成本较低（低209欧元），但被初级医疗保健提供者较高的成本（高66欧元）部分抵消。3天组患者入院及随访期间资源利用产生的平均成本估计为3959欧元，而8天组为4102欧元（差异为143欧元，支持较短疗程治疗）。该差异受住院单位成本假设变化的影响，但始终支持较短疗程治疗。
无并发症肺炎住院患者抗生素治疗疗程缩短不会导致资源利用大量转向初级医疗保健提供者。由于3天抗生素治疗不会导致较差的临床结果，这些发现支持3天治疗作为一种更有效的策略。
