Research Centre for Pharmaceutical Care and Pharmacoeconomics, KU Leuven, Onderwijs en Navorsing 2, P.O. Box 521, Herestraat 49, 3000 Leuven, Belgium.
Respir Med. 2013 May;107(5):637-48. doi: 10.1016/j.rmed.2012.12.019. Epub 2013 Jan 23.
Long-term treatment with macrolides has recently been shown to reduce COPD exacerbations in doses lower than bactericidal doses. This article aims to critically review the international literature relating to the long-term effectiveness and safety of macrolides and to estimate the budget impact of preventing exacerbations with azithromycin in Belgium. Controlled clinical studies focusing on the prevention of COPD exacerbations with long-term macrolide treatment were identified in PubMed, EMBASE, Controlled Trials Registry of the Cochrane Library, and Social Science and Citation Index. The budget impact of preventing exacerbations with azithromycin in Belgium over a one-year period was calculated as the difference between the additional expenditure of annual treatment with azithromycin and the savings in hospital expenditure arising from fewer COPD exacerbations in patients with GOLD stages II-IV. Prevalence and resource use data were derived from the literature and unit cost data from Belgian sources. The literature review suggests that long-term treatment of COPD patients with azithromycin, erythromycin or clarithromycin is effective and safe, and reduces exacerbations and related hospitalizations. However, uncertainty remains about the specific patient population that is most likely to benefit from long-term macrolide treatment, the optimal dose and duration of macrolide treatment, and the potential impact of long-term macrolide treatment on resistance. The budget impact analysis demonstrated that annual hospital savings of €950 million resulting from fewer exacerbations outweighed additional expenditure on azithromycin of €595 million, implying that the prevention of COPD exacerbations with azithromycin is a cost saving strategy in Belgium.
大环内酯类药物的长期治疗最近已被证明可降低 COPD 恶化率，且用药剂量低于杀菌剂量。本文旨在对大环内酯类药物长期有效性和安全性的国际文献进行批判性评估，并估计在比利时使用阿奇霉素预防 COPD 恶化的预算影响。在 PubMed、EMBASE、Cochrane 图书馆对照试验登记处和社会科学引文索引中确定了关注长期大环内酯类药物治疗预防 COPD 恶化的对照临床试验。在比利时，使用阿奇霉素预防恶化的预算影响是通过计算年度阿奇霉素治疗的额外支出与因 GOLD 分期 II-IV 患者 COPD 恶化减少而节省的医院支出之间的差异来确定的。患病率和资源使用数据源自文献，单位成本数据源自比利时来源。文献综述表明，对 COPD 患者使用阿奇霉素、红霉素或克拉霉素进行长期治疗是有效且安全的，可减少恶化和相关住院治疗。但是，对于最有可能从长期大环内酯类药物治疗中获益的特定患者人群、大环内酯类药物治疗的最佳剂量和持续时间以及长期大环内酯类药物治疗对耐药性的潜在影响，仍存在不确定性。预算影响分析表明，由于恶化减少而节省的每年 9.5 亿欧元的医院支出超过了阿奇霉素的 5.95 亿欧元的额外支出，这表明在比利时使用阿奇霉素预防 COPD 恶化是一种节省成本的策略。
