van Werkhoven Cornelis H, Postma Douwe F, Mangen Marie-Josee J, Oosterheert Jan Jelrik, Bonten Marc J M
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
Department of Internal Medicine and Infectious Diseases, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
BMC Infect Dis. 2017 Jan 10;17(1):52. doi: 10.1186/s12879-016-2179-6.
To determine the cost-effectiveness of strategies of preferred antibiotic treatment with beta-lactam/macrolide combination or fluoroquinolone monotherapy compared to beta-lactam monotherapy.
Costs and effects were estimated using data from a cluster-randomized cross-over trial of antibiotic treatment strategies, primarily from the reduced third payer perspective (i.e. hospital admission costs). Cost-minimization analysis (CMA) and cost-effectiveness analysis (CEA) were performed using linear mixed models. CMA results were expressed as difference in costs per patient. CEA results were expressed as incremental cost-effectiveness ratios (ICER) showing additional costs per prevented death.
A total of 2,283 patients were included. Crude average costs within 90 days from the reduced third payer perspective were €4,294, €4,392, and €4,002 per patient for the beta-lactam monotherapy, beta-lactam/macrolide combination, and fluoroquinolone monotherapy strategy, respectively. CMA results were €106 (95% CI €-697 to €754) for the beta-lactam/macrolide combination strategy and €-278 (95%CI €-991 to €396) for the fluoroquinolone monotherapy strategy, both compared to the beta-lactam monotherapy strategy. The ICER was not statistically significantly different between the strategies. Other perspectives yielded similar results.
There were no significant differences in cost-effectiveness of strategies of preferred antibiotic treatment of CAP on non-ICU wards with either beta-lactam monotherapy, beta-lactam/macrolide combination therapy, or fluoroquinolone monotherapy.
The trial was registered with ClinicalTrials.gov, number NCT01660204 , on May 2nd, 2012.
确定β-内酰胺/大环内酯类联合用药或氟喹诺酮类单药治疗作为首选抗生素治疗策略相较于β-内酰胺类单药治疗的成本效益。
使用抗生素治疗策略的整群随机交叉试验数据估算成本和效果，主要从降低的第三方支付者角度（即住院费用）进行。使用线性混合模型进行成本最小化分析（CMA）和成本效益分析（CEA）。CMA结果以每位患者的成本差异表示。CEA结果以增量成本效益比（ICER）表示，即每预防一例死亡的额外成本。
共纳入2283例患者。从降低的第三方支付者角度来看，β-内酰胺类单药治疗、β-内酰胺/大环内酯类联合用药和氟喹诺酮类单药治疗策略的患者90天内的粗平均成本分别为每人4294欧元、4392欧元和4002欧元。与β-内酰胺类单药治疗策略相比，β-内酰胺/大环内酯类联合用药策略的CMA结果为106欧元（95%CI -697欧元至754欧元），氟喹诺酮类单药治疗策略的CMA结果为 -278欧元（95%CI -991欧元至396欧元）。各策略之间的ICER在统计学上无显著差异。其他角度得出了类似结果。
在非重症监护病房中，采用β-内酰胺类单药治疗、β-内酰胺/大环内酯类联合治疗或氟喹诺酮类单药治疗作为首选抗生素治疗社区获得性肺炎的策略，其成本效益无显著差异。
该试验于2012年5月2日在ClinicalTrials.gov注册，编号为NCT01660204。
