Simoens Steven
Research Centre for Pharmaceutical Care and Pharmaco-economics, Faculty of Pharmaceutical Sciences, Katholieke Universiteit Leuven. Onderwijs en Navorsing 2, Herestraat 49, P.O. Box 521, 3000 Leuven, Belgium.
Curr Med Res Opin. 2009 Oct;25(10):2447-57. doi: 10.1185/03007990903223663.
In an era of limited resources, policy makers and health care payers are concerned about the costs of treatment in addition to its effectiveness. However, guidelines do not tend to consider the cost-effectiveness of treatment options. This paper aims to conduct an international literature review with a view to assessing the impact of pharmaco-economic considerations of CAP treatment with moxifloxacin on recent guidelines.
The pharmaco-economic state of the art of treating CAP with moxifloxacin is assessed and compared with guidelines issued by the European Respiratory Society and by the Infectious Diseases Society of America/American Thoracic Society. Also, evidence on moxifloxacin consumption and antimicrobial resistance, and the impact of resistance on the cost-effectiveness of moxifloxacin is reviewed. Studies were identified by searching PubMed, Centre for Reviews and Dissemination databases, Cochrane Database of Systematic Reviews, and EconLit up to January 2009.
The existing pharmaco-economic evidence indicates that moxifloxacin is a cost-effective treatment for CAP. However, data limitations and uncertainty surrounding the evolution of resistance emphasize the need for caution. As recommended by guidelines, the choice of antimicrobial should consider the local frequency of causative pathogens, the local pattern of antimicrobial resistance, and risk factors for resistant bacteria. The pharmaco-economic evidence corroborates the importance of these factors as they have an impact on the cost-effectiveness of treating CAP patients with moxifloxacin.
CAP guidelines need to take into account pharmaco-economic considerations by balancing the effectiveness of antimicrobial regimens against their costs. The pharmaco-economic value of moxifloxacin is influenced by the causative pathogens involved and resistance patterns. Therefore, it may be advisable to identify patient subgroups in which treatment with moxifloxacin is cost-effective and should be recommended by guidelines.
在资源有限的时代，政策制定者和医疗保健支付方除了关注治疗效果外，还关心治疗成本。然而，指南往往未考虑治疗方案的成本效益。本文旨在进行一项国际文献综述，以评估莫西沙星治疗社区获得性肺炎（CAP）的药物经济学考量对近期指南的影响。
评估用莫西沙星治疗CAP的药物经济学现状，并与欧洲呼吸学会以及美国传染病学会/美国胸科学会发布的指南进行比较。此外，还综述了有关莫西沙星使用情况和抗菌药物耐药性的证据，以及耐药性对莫西沙星成本效益的影响。通过检索截至2009年1月的PubMed、综述与传播中心数据库、Cochrane系统评价数据库和EconLit来确定研究。
现有的药物经济学证据表明，莫西沙星是一种治疗CAP的具有成本效益的药物。然而，数据局限性以及围绕耐药性演变的不确定性强调了谨慎的必要性。正如指南所建议的，抗菌药物的选择应考虑致病病原体的当地流行频率、当地的抗菌药物耐药模式以及耐药菌的危险因素。药物经济学证据证实了这些因素的重要性，因为它们会影响用莫西沙星治疗CAP患者的成本效益。
CAP指南需要通过平衡抗菌治疗方案的有效性和成本来考虑药物经济学因素。莫西沙星的药物经济学价值受所涉及的致病病原体和耐药模式的影响。因此，识别出使用莫西沙星治疗具有成本效益且应由指南推荐的患者亚组可能是明智的。
