Kimura S-I, Murata T, Akahoshi Y, Nakano H, Ugai T, Wada H, Yamasaki R, Ishihara Y, Kawamura K, Sakamoto K, Ashizawa M, Sato M, Terasako-Saito K, Nakasone H, Kikuchi M, Yamazaki R, Kako S, Kanda J, Tanihara A, Nishida J, Kanda Y
Division of Hematology, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya-ku, Saitama-city, Saitama, 330-8503, Japan.
Eur J Clin Microbiol Infect Dis. 2015 May;34(5):951-61. doi: 10.1007/s10096-014-2311-8. Epub 2015 Jan 11.
We compared the expected medical costs of empirical and preemptive treatment strategies for invasive fungal infection in neutropenic patients with hematological diseases. Based on the results of two clinical trials with different backgrounds reported by Oshima et al. [J Antimicrob Chemother 60(2):350-355; Oshima study] and Cordonnier et al. [Clin Infect Dis 48(8):1042-1051; PREVERT study], we developed a decision tree model that represented the outcomes of empirical and preemptive treatment strategies, and estimated the expected medical costs of medications and examinations in the two strategies. We assumed that micafungin was started in the empirical group at 5 days after fever had developed, while voriconazole was started in the preemptive group only when certain criteria, such as positive test results of imaging studies and/or serum markers, were fulfilled. When we used an incidence of positive test results of 6.7 % based on the Oshima study, the expected medical costs of the empirical and preemptive groups were 288,198 and 150,280 yen, respectively. Even in the case of the PREVERT study, in which the incidence of positive test results was 32.9 %, the expected medical costs in the empirical and preemptive groups were 291,871 and 284,944 yen, respectively. A sensitivity analysis indicated that the expected medical costs in the preemptive group would exceed those in the empirical group when the incidence of positive test results in the former was over 34.4 %. These results suggest that a preemptive treatment strategy can be expected to reduce medical costs compared with empirical therapy in most clinical settings.
我们比较了血液系统疾病中性粒细胞减少患者侵袭性真菌感染经验性治疗策略和抢先治疗策略的预期医疗费用。基于大岛等人[《抗菌化学疗法杂志》60(2):350 - 355；大岛研究]和科尔东尼尔等人[《临床感染病杂志》48(8):1042 - 1051；PREVERT研究]报道的两项背景不同的临床试验结果，我们构建了一个决策树模型来呈现经验性治疗策略和抢先治疗策略的结果，并估算了这两种策略中药物和检查的预期医疗费用。我们假设经验性治疗组在发热出现5天后开始使用米卡芬净，而抢先治疗组仅在满足某些标准（如影像学检查和/或血清标志物检测结果为阳性）时才开始使用伏立康唑。当我们根据大岛研究采用6.7%的检测结果阳性发生率时，经验性治疗组和抢先治疗组的预期医疗费用分别为288,198日元和150,280日元。即使在检测结果阳性发生率为32.9%的PREVERT研究中，经验性治疗组和抢先治疗组的预期医疗费用分别为291,871日元和284,944日元。敏感性分析表明，当抢先治疗组检测结果阳性发生率超过34.4%时，其预期医疗费用将超过经验性治疗组。这些结果表明，在大多数临床情况下，与经验性治疗相比，抢先治疗策略有望降低医疗费用。
