Marra F, Marra C A, Patrick D M
Department of Pharmacy, Vancouver Hospital and Health Sciences Centre; Faculty of Pharmaceutical Sciences and Division of Infectious Diseases, Faculty of Medicine, University of British Columbia; Pharmaceutical Outcomes Research Program, British Columbia's Children's and Women's Hospitals, Vancouver, British Columbia.
Can J Infect Dis. 1997 Jul;8(4):202-8. doi: 10.1155/1997/870203.
To assess the cost effectiveness of azithromycin versus doxycycline therapy for cervical Chlamydia trachomatis infections in Canada.
A predictive decision analytic model using previously published clinical and economic evaluations, expert opinion and costs of medical care in Canada.
A hypothetical cohort of 5000 women followed over 10 years.
Two diagnostic strategies were compared, laboratory confirmed diagnosis (LCD) and presumptive diagnosis (PD) of C trachomatis infection. Under each strategy, two treatment alternatives were analyzed, a single 1 g dose of azithromycin and a seven-day course of doxycycline as 100 mg twice daily.
Despite a fourfold higher acquisition cost, under base case conditions, for both diagnostic strategies, the azithromycin treatment alternative was more cost effective than the doxycycline alternative. For the LCD model, the cost per cure for patients receiving azithromycin was $184.76 compared with $240.59 for patients receiving doxycycline, resulting in an incremental cost of $55.83. For the PD model, the cost per cure for patients treated with azithromycin was $51.48 compared with $51.82, resulting in an incremental cost of $0.34. For the hypothetical cohort of 5000 women, the use of azithromycin translates into a projected annual cost savings of $279,150 and $1,700 for the LCD and PD models, respectively. In one-way sensitivity analyses for the LCD model, no clinically plausible changes in the base case estimates changed the results of the cost effectiveness outcome. In the PD model, clinically plausible changes in the probabilities of doxycycline cure, pelvic inflammatory disease, sequelae and chlamydia infection were found to alter the cost effectiveness outcome.
Based on the results from our model, the azithromycin strategy should be employed for the treatment of laboratory confirmed cases. However, for presumptive cases, azithromycin should be used only if the probabilities of C trachomatis and pelvic inflammatory disease are more than 19%, doxycycline effectiveness is less than 78%, or the cost of azithromycin is less than $19.00.
评估阿奇霉素与多西环素治疗加拿大宫颈沙眼衣原体感染的成本效益。
采用先前发表的临床和经济评估、专家意见以及加拿大医疗保健成本构建预测性决策分析模型。
一个假设的5000名女性队列，随访10年。
比较两种诊断策略，即沙眼衣原体感染的实验室确诊诊断（LCD）和推定诊断（PD）。在每种策略下，分析两种治疗方案，单次1克剂量的阿奇霉素和为期7天、每日两次、每次100毫克的多西环素疗程。
尽管阿奇霉素的采购成本高出四倍，但在基础病例条件下，对于两种诊断策略，阿奇霉素治疗方案均比多西环素方案更具成本效益。对于LCD模型，接受阿奇霉素治疗的患者每治愈一例的成本为184.76美元，而接受多西环素治疗的患者为240.59美元，增量成本为55.83美元。对于PD模型，接受阿奇霉素治疗的患者每治愈一例的成本为51.48美元，多西环素为51.82美元，增量成本为0.34美元。对于假设的5000名女性队列，使用阿奇霉素预计每年分别为LCD和PD模型节省成本279,150美元和1,700美元。在LCD模型的单向敏感性分析中，基础病例估计中任何临床上合理的变化都未改变成本效益结果。在PD模型中，发现多西环素治愈率、盆腔炎、后遗症和衣原体感染概率的临床上合理变化会改变成本效益结果。
根据我们模型的结果，阿奇霉素策略应用于治疗实验室确诊病例。然而，对于推定病例，仅当沙眼衣原体和盆腔炎的概率超过19%、多西环素有效性低于78%或阿奇霉素成本低于19.00美元时，才应使用阿奇霉素。
