Grau Santiago, Lozano Virginia, Valladares Amparo, Cavanillas Rafael, Xie Yang, Nocea Gonzalo
Hospital del Mar, Barcelona, Spain.
Pharmacoeconomics and Outcomes Research Iberia, Madrid, Spain.
Clinicoecon Outcomes Res. 2014 Feb 13;6:83-92. doi: 10.2147/CEOR.S55265. eCollection 2014.
Clinical efficacy of antibiotics may be affected by changes in the susceptibility of microorganisms to antimicrobial agents. The purpose of this study is to assess how these changes could affect the initial efficacy of ertapenem and ceftriaxone in the treatment of community-acquired pneumonia (CAP) in elderly patients and the potential consequences this may have in health care costs.
Initial efficacy in elderly was obtained from a combined analysis of two multicenter, randomized studies. An alternative scenario was carried out using initial efficacy data according to the pneumonia severity index (PSI). Country-specific pathogens distribution was obtained from a national epidemiological study, and microbiological susceptibilities to first- and second-line therapies were obtained from Spanish or European surveillance studies. A decision analytic model was used to compare ertapenem versus ceftriaxone for CAP inpatient treatment. Inputs of the model were the expected effectiveness previously estimated and resource use considering a Spanish national health system perspective. Outcomes include difference in proportion of successfully treated patients and difference in total costs between ertapenem and ceftriaxone. The model performed one-way and probabilistic sensitivity analyses.
First-line treatment of CAP with ertapenem led to a higher proportion of successfully treated patients compared with ceftriaxone in Spain. One-way sensitivity analysis showed that length of stay was the key parameter of the model. Probabilistic sensitivity analysis showed that ertapenem can be a cost-saving strategy compared with ceftriaxone, with a 59% probability of being dominant (lower costs with additional health benefits) for both, elderly patients (>65 years) and patients with PSI >3.
The incorporation of the current antimicrobial susceptibility into the initial clinical efficacy has a significant impact in outcomes and costs in CAP treatment. The treatment with ertapenem compared with ceftriaxone resulted in better clinical outcomes and lower treatment costs for two segments of the Spanish population: elderly patients and patients with severe pneumonia (PSI >3).
微生物对抗菌药物敏感性的变化可能会影响抗生素的临床疗效。本研究旨在评估这些变化如何影响厄他培南和头孢曲松在老年患者社区获得性肺炎（CAP）治疗中的初始疗效，以及这可能对医疗成本产生的潜在影响。
老年患者的初始疗效来自两项多中心随机研究的联合分析。根据肺炎严重程度指数（PSI），使用初始疗效数据进行了另一种情况分析。特定国家的病原体分布来自一项全国性流行病学研究，对一线和二线治疗的微生物敏感性来自西班牙或欧洲的监测研究。使用决策分析模型比较厄他培南和头孢曲松用于CAP住院治疗的情况。该模型的输入是先前估计的预期有效性以及从西班牙国家卫生系统角度考虑的资源使用情况。结果包括成功治疗患者比例的差异以及厄他培南和头孢曲松之间总成本的差异。该模型进行了单向和概率敏感性分析。
在西班牙，与头孢曲松相比，使用厄他培南一线治疗CAP导致成功治疗的患者比例更高。单向敏感性分析表明，住院时间是该模型的关键参数。概率敏感性分析表明，与头孢曲松相比，厄他培南可能是一种节省成本的策略，对于老年患者（>65岁）和PSI>3的患者，其具有59%的概率占优（成本更低且有额外健康益处）。
将当前的抗菌药物敏感性纳入初始临床疗效对CAP治疗的结果和成本有重大影响。与头孢曲松相比，厄他培南治疗使西班牙两类人群的临床结果更好且治疗成本更低：老年患者和重症肺炎患者（PSI>3）。
