Grau Santiago, Lozano Virginia, Valladares Amparo, Cavanillas Rafael, Xie Yang, Nocea Gonzalo
Hospital del Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain,
Appl Health Econ Health Policy. 2015 Aug;13(4):369-79. doi: 10.1007/s40258-015-0162-9.
The microbial susceptibility of many antibiotics has been affected by prescribing patterns and their extensive use. The purpose of this evaluation was to assess how these changes could affect the initial efficacy of ertapenem and piperacillin/tazobactam in the treatment of complicated intra-abdominal infections (IAIs) acquired in the community and the potential consequences this may have in healthcare costs in Spain.
The Initial efficacy of ertapenem and piperacillin/tazobactam for patients with APACHE (Acute Physiology and Chronic Health Evaluation) II scores <10 was extracted from a multicenter randomized study and were combined with the current microbial susceptibilities obtained from the SMART study, a multinational surveillance program. Country-specific pathogens distribution was extracted from a national study in patients with community-acquired IAI. The estimated effectiveness was used in a decision-analytic model to compare total costs between ertapenem and piperacillin/tazobactam in the treatment of complicated IAI. The model performs extensive one-way and probabilistic sensitivity analyses.
The model suggested a savings of €209 (year 2012 values) per patient when complicated IAIs acquired in the community (APACHE II <10) were treated with ertapenem instead of piperacillin/tazobactam. One-way sensitivity analyses showed length of stay as the key driver parameter. Further analysis of this parameter and probabilistic sensitivity analysis confirmed the robustness of our evaluation, with a 58% likelihood of ertapenem being dominant.
Ertapenem appears to be a cost-saving strategy over piperacillin/tazobactam for the treatment of patients with complicated IAIs acquired in the community in Spain.
许多抗生素的微生物敏感性受到处方模式及其广泛使用的影响。本评估的目的是评估这些变化如何影响厄他培南和哌拉西林/他唑巴坦在治疗社区获得性复杂性腹腔内感染（IAI）时的初始疗效，以及这可能对西班牙医疗成本产生的潜在影响。
从一项多中心随机研究中提取厄他培南和哌拉西林/他唑巴坦用于急性生理与慢性健康状况评估（APACHE）II评分<10患者的初始疗效，并与从多国监测项目SMART研究中获得的当前微生物敏感性数据相结合。从一项关于社区获得性IAI患者的全国性研究中提取特定国家的病原体分布情况。将估计的有效性用于决策分析模型，以比较厄他培南和哌拉西林/他唑巴坦治疗复杂性IAI的总成本。该模型进行了广泛的单向和概率敏感性分析。
该模型表明，对于社区获得性复杂性IAI（APACHE II<10）患者，使用厄他培南而非哌拉西林/他唑巴坦治疗时，每位患者可节省209欧元（2012年价值）。单向敏感性分析表明住院时间是关键驱动参数。对该参数的进一步分析和概率敏感性分析证实了我们评估的稳健性，厄他培南占优的可能性为58%。
在西班牙，对于治疗社区获得性复杂性IAI患者，厄他培南似乎是一种比哌拉西林/他唑巴坦更具成本效益的策略。
