Michaelidis Constantinos I, Kern Melissa S, Smith Kenneth J
Division of General Medicine and Primary Care, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Institute for Advanced Application, Geisinger Health System, Danville, PA, USA.
J Gen Intern Med. 2015 Oct;30(10):1505-10. doi: 10.1007/s11606-015-3289-3.
A recent clinical trial suggests that printed (PDS) and computer decision support (CDS) interventions are safe and effective in reducing antibiotic use in acute bronchitis relative to usual care (UC).
Our aim was to evaluate the cost-effectiveness of decision support interventions in reducing antibiotic use in acute bronchitis.
We conducted a clinical trial-based cost-effectiveness analysis comparing UC, PDS and CDS for management of acute bronchitis. We assumed a societal perspective, 5-year program duration and 30-day time horizon.
The U.S. population aged 13-64 years presenting with acute bronchitis in the ambulatory setting.
Printed and computer decision support interventions relative to usual care.
Cost per antibiotic prescription safely avoided.
In the base case, PDS dominated UC and CDS, with lesser total costs (PDS: $2,574, UC: $2,768, CDS: $2,805) and fewer antibiotic prescriptions (PDS: 3.79, UC: 4.60, CDS: 3.95) per patient over 5 years. In one-way sensitivity analyses, PDS dominated UC across all parameter values, except when antibiotics reduced work loss by ≥ 1.9 days or the probability of hospitalization within 30 days was ≥ 0.9 % in PDS (base case: 0.2 %) or ≤ 0.4 % in UC (base case: 1.0 %). The dominance of PDS over CDS was sensitive both to probability of hospitalization and plausible variation in the adjusted odds of antibiotic use in both strategies.
A PDS strategy to reduce antibiotic use in acute bronchitis is less costly and more effective than both UC and CDS strategies, although results were sensitive to variation in probability of hospitalization and the adjusted odds of antibiotic use. This simple, low-cost, safe, and effective intervention would be an economically reasonable component of a multi-component approach to address antibiotic overuse in acute bronchitis.
最近一项临床试验表明，相对于常规治疗（UC），印刷版（PDS）和计算机决策支持（CDS）干预措施在减少急性支气管炎抗生素使用方面是安全有效的。
我们的目的是评估决策支持干预措施在减少急性支气管炎抗生素使用方面的成本效益。
我们进行了一项基于临床试验的成本效益分析，比较UC、PDS和CDS在急性支气管炎管理中的效果。我们采用社会视角，项目持续时间为5年，时间跨度为30天。
13 - 64岁在门诊就诊的急性支气管炎美国患者。
相对于常规治疗的印刷版和计算机决策支持干预措施。
安全避免的每张抗生素处方成本。
在基础案例中，PDS优于UC和CDS，5年内每位患者的总成本更低（PDS：2574美元，UC：2768美元，CDS：2805美元），抗生素处方更少（PDS：3.79，UC：4.60，CDS：3.95）。在单向敏感性分析中，除了抗生素减少误工天数≥1.9天或PDS中30天内住院概率≥0.9%（基础案例：0.2%）或UC中≤0.4%（基础案例：1.0%）的情况外，PDS在所有参数值下均优于UC。PDS相对于CDS的优势对住院概率以及两种策略中抗生素使用调整后比值的合理变化均敏感。
尽管结果对住院概率变化和抗生素使用调整后比值敏感，但减少急性支气管炎抗生素使用的PDS策略比UC和CDS策略成本更低且更有效。这种简单、低成本、安全且有效的干预措施将是解决急性支气管炎抗生素过度使用的多成分方法中经济合理的组成部分。
