Rubio-Terrés Carlos, Rubio-Rodríguez Darío, Majos Nuria, Grau Santiago
HEALTH VALUE, C/ Virgen de Aránzazu, 21. 5ºB, 28034, Madrid, Spain.
Rev Esp Quimioter. 2012 Dec;25(4):283-92.
The increased morbidity, mortality and high costs associated with bacteremia caused by methicillin-resistant Staphylococcus aureus (MRSA) is a major public health problem. Pharmacoeconomic analysis was performed to compare the efficiency of daptomycin (DAP) against vancomycin (VAN) in the treatment of this infection.
Retrospective, deterministic and probabilistic cost-effectiveness analysis. The effectiveness of the treatments was estimated from the results of a randomized clinical trial, which compared DAP (6 mg / kg IV daily) and VAN (1 g IV every 12 hours), both with or without gentamicin (1 mg / kg IV every 8 hours). Resource utilization was estimated from the clinical trial of the drug datasheets and Spanish sources, the unit costs were obtained also from Spanish sources. Monte Carlo probabilistic analysis and deterministic analysis were performed.
The clinical trial cure rates were higher with DAP (44.4%, 95% CI 43.5 to 45.4%) than with VAN (31.8%, 95% CI 30.9 to 32.7%) not statistically significant (p = 0.2203) but with economic impact. With DAP would occur less costs due to treatment failure (rescue antibiotics, additional tests, prolonged hospital stay and adverse reactions) than with VAN. In the base case the average cost of disease per patient was € 12,329 to € 12,696 with DAP and VAN (difference of 367 €). DAP treatment was dominant (more effective, with lower costs than VAN) both in the deterministic and probabilistic analysis. In the Monte Carlo simulation, DAP was the most cost-effective treatment in 100% of the 10,000 simulations, for a willingness to pay € 12,000 per additional cure (approximate cost of MRSA bacteraemia episode).
According to this model, daptomycin is more cost-effective than vancomycin in treating MRSA bacteremia. The higher cost of acquisition of daptomycin does not imply a higher cost of treating this infection.
耐甲氧西林金黄色葡萄球菌（MRSA）引起的菌血症导致发病率、死亡率增加以及成本高昂，这是一个重大的公共卫生问题。进行了药物经济学分析，以比较达托霉素（DAP）和万古霉素（VAN）治疗这种感染的疗效。
回顾性、确定性和概率性成本效益分析。根据一项随机临床试验的结果估计治疗效果，该试验比较了DAP（每日静脉注射6mg/kg）和VAN（每12小时静脉注射1g），两者均联合或不联合庆大霉素（每8小时静脉注射1mg/kg）。根据药物说明书的临床试验和西班牙资料估计资源利用情况，单位成本也来自西班牙资料。进行了蒙特卡洛概率分析和确定性分析。
DAP的临床试验治愈率（44.4%，95%可信区间43.5%至45.4%）高于VAN（31.8%，95%可信区间30.9%至32.7%），虽无统计学显著性差异（p = 0.2203），但有经济影响。与VAN相比，使用DAP因治疗失败（挽救性抗生素、额外检查、延长住院时间和不良反应）导致的成本更低。在基础病例中，DAP和VAN治疗每位患者的疾病平均成本分别为12329欧元至12696欧元（相差367欧元）。在确定性分析和概率性分析中，DAP治疗均占优势（更有效，成本低于VAN）。在蒙特卡洛模拟中，对于每额外治愈一例愿意支付12000欧元（MRSA菌血症发作的近似成本），在10000次模拟中有100%的情况DAP是最具成本效益的治疗方法。
根据该模型，达托霉素治疗MRSA菌血症比万古霉素更具成本效益。达托霉素较高的获取成本并不意味着治疗这种感染的成本更高。
