耐甲氧西林金黄色葡萄球菌所致医院获得性肺炎中国患者使用利奈唑胺或万古霉素治疗的经济学评价：基于4期临床试验研究的事后分析
Economic evaluation among Chinese patients with nosocomial pneumonia caused by methicillin-resistant Staphylococcus aureus and treated with linezolid or vancomycin: a secondary, post-hoc analysis based on a Phase 4 clinical trial study.
作者信息
Wan Yin, Li Qiang, Chen Yixi, Haider Seema, Liu Sizhu, Gao Xin
机构信息
a a Pharmerit International , Bethesda , MD , USA.
b b Surgical Intensive Care Unit, Department of General Surgery, Jiangsu Province Hospital , Nanjing , PR China.
出版信息
J Med Econ. 2016;19(1):53-62. doi: 10.3111/13696998.2015.1088448. Epub 2015 Oct 22.
OBJECTIVE
To assess cost-effectiveness of linezolid vs vancomycin in treating nosocomial pneumonia caused by methicillin-resistant Staphylococcus aureus (MRSA-NP) in China and the impact of renal failure on healthcare resource utilization (HCRU) and costs.
METHODS
Cost-effectiveness analysis was conducted based on data from the ZEPHyR trial, with efficacy measured by treatment success and costs calculated from HCRU. Confidence intervals (CI) for cost, efficacy and incremental cost-effectiveness ratios (ICER) were calculated by non-parametric bootstrap. Chi-square test was used for renal failure rate and t-test for HCRU/cost comparisons. Impact of renal failure was assessed using regression model.
RESULTS
Data from 448 patients (1:1 linezolid:vancomycin) were analyzed. More patients treated with linezolid achieved success (55% [95% CI = 48-62%]) than with vancomycin (45% [38-52%]). Treatment cost were ¥79,551 (95% CI = ¥72,421-¥86,680) for linezolid vs ¥77,587 (¥70,656-¥84,519) for vancomycin in Beijing, ¥90,995 (¥82,598-¥99,393) vs ¥89,448 (¥81,295-¥97,601) in Guangzhou, ¥82,383 (¥74,956-¥89,810) vs ¥80,799 (¥73,545-¥88,054) in Nanjing and ¥59,413 (¥54,366-¥64,460) vs ¥57,804 (¥52,613-¥62,996) in Xi'an. Per successful treatment, the ICER of linezolid over vancomycin were ¥19,719 (-¥143,553 to ¥320,980) (Beijing), ¥15,532 (-¥185,411 to ¥349,693) (Guangzhou), ¥15,904 (-¥161,935 to ¥314,987) (Nanjing) and ¥16,145 (-¥100,738 to ¥234,412) (Xi'an). From simulations, the majority of linezolid cases had greater efficacy and higher costs and more than one third had greater efficacy and lower costs. More vancomycin patients developed renal failure (15% vs 4%, p < 0.001). Patients with renal failure had higher cost (Nanjng: ¥100,449 (SD = ¥65,080) vs ¥74,944 (SD = ¥49,632), p = 0.002).
CONCLUSION
Linezolid was more cost-effective than vancomycin in treating MRSA-NP from a Chinese payer's perspective, and associated with less renal failure, HCRU and cost.
目的
评估在中国，利奈唑胺与万古霉素治疗耐甲氧西林金黄色葡萄球菌引起的医院获得性肺炎（MRSA-NP）的成本效益，以及肾衰竭对医疗资源利用（HCRU）和成本的影响。
方法
基于ZEPHyR试验的数据进行成本效益分析，疗效通过治疗成功来衡量，成本根据HCRU计算。成本、疗效和增量成本效益比（ICER）的置信区间（CI）通过非参数自助法计算。采用卡方检验分析肾衰竭发生率，采用t检验比较HCRU/成本。使用回归模型评估肾衰竭的影响。
结果
分析了448例患者的数据（利奈唑胺：万古霉素 = 1:1）。接受利奈唑胺治疗的患者成功治疗的比例（55% [95% CI = 48-62%]）高于接受万古霉素治疗的患者（45% [38-52%]）。在北京，利奈唑胺的治疗成本为79,551元（95% CI = 72,421-86,680元），万古霉素为77,587元（70,656-84,519元）；在广州，分别为90,995元（82,598-99,393元）和89,448元（81,295-97,601元）；在南京，分别为82,383元（74,956-89,810元）和80,799元（73,545-88,054元）；在西安，分别为59,413元（54,366-64,460元）和57,804元（52,613-62,996元）。每成功治疗一例，利奈唑胺相对于万古霉素的ICER在北京为19,719元（-143,553至320,980元），在广州为15,532元（-185,411至349,693元），在南京为15,904元（-161,935至314,987元），在西安为16,145元（-100,738至234,412元）。通过模拟，大多数使用利奈唑胺的病例疗效更高且成本更高，超过三分之一的病例疗效更高且成本更低。更多使用万古霉素的患者发生肾衰竭（15% 对 4%，p < 0.001）。肾衰竭患者成本更高（南京：100,449元（标准差 = 65,080元）对74,944元（标准差 = 49,632元），p = 0.002）。
结论
从中国医保支付方的角度来看，利奈唑胺治疗MRSA-NP比万古霉素更具成本效益，且与较少的肾衰竭、HCRU和成本相关。
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