剖宫产术中阿奇霉素辅助预防性应用的经济学评价
Economic Evaluation of Adjunctive Azithromycin Prophylaxis for Cesarean Delivery.
作者信息
Harper Lorie M, Kilgore Meredith, Szychowski Jeff M, Andrews William W, Tita Alan T N
机构信息
Center for Women's Reproductive Health, Department of Obstetrics and Gynecology, and the School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama.
出版信息
Obstet Gynecol. 2017 Aug;130(2):328-334. doi: 10.1097/AOG.0000000000002129.
OBJECTIVE
To compare the costs associated with adjunctive azithromycin compared with standard cefazolin antibiotic prophylaxis alone for unscheduled and scheduled cesarean deliveries.
METHODS
A decision analytic model was created to compare cefazolin alone with azithromycin plus cefazolin. Published incidences of surgical site infection after cesarean delivery were used to estimate the baseline incidence of surgical site infection in scheduled and unscheduled cesarean delivery using standard antibiotic prophylaxis. The effectiveness of adjunctive azithromycin prophylaxis was obtained from published randomized controlled trials for unscheduled cesarean deliveries. No randomized study of its use in scheduled procedures has been completed. Cost estimates were obtained from published literature, hospital estimates, and the Healthcare Cost and Utilization Project and considered costs of azithromycin and surgical site infections. A series of sensitivity analyses were conducted by varying parameters in the model based on observed distributions for probabilities and costs. The outcome was cost per cesarean delivery from a health system perspective.
RESULTS
For unscheduled cesarean deliveries, cefazolin prophylaxis alone would cost $695 compared with $335 for adjunctive azithromycin prophylaxis, resulting in a savings of $360 (95% CI $155-451) per cesarean delivery. In scheduled cesarean deliveries, cefazolin prophylaxis alone would cost $254 compared with $111 for adjunctive azithromycin prophylaxis, resulting in a savings of $143 (95% CI 98-157) per cesarean delivery, if proven effective. These findings were robust to a multitude of inputs; as long as adjunctive azithromycin prevented as few as seven additional surgical site infections per 1,000 unscheduled cesarean deliveries and nine additional surgical site infections per 10,000 scheduled cesarean deliveries, adjunctive azithromycin prophylaxis was cost-saving.
CONCLUSION
Adjunctive azithromycin prophylaxis is a cost-saving strategy in both unscheduled and scheduled cesarean deliveries.
目的
比较在计划内和计划外剖宫产中，辅助使用阿奇霉素与仅使用标准头孢唑林进行抗生素预防的成本。
方法
创建一个决策分析模型，比较单独使用头孢唑林与阿奇霉素加头孢唑林的情况。利用已发表的剖宫产术后手术部位感染发生率，估计使用标准抗生素预防措施时计划内和计划外剖宫产手术部位感染的基线发生率。辅助使用阿奇霉素预防的有效性来自已发表的关于计划外剖宫产的随机对照试验。尚未完成关于其在计划内手术中使用的随机研究。成本估计来自已发表的文献、医院估计以及医疗成本与利用项目，并考虑了阿奇霉素和手术部位感染的成本。基于观察到的概率和成本分布，通过改变模型中的参数进行了一系列敏感性分析。结果是从卫生系统角度计算的每例剖宫产成本。
结果
对于计划外剖宫产，单独使用头孢唑林预防的成本为695美元，而辅助使用阿奇霉素预防的成本为335美元，每例剖宫产节省360美元（95%可信区间为155 - 451美元）。在计划内剖宫产中，单独使用头孢唑林预防的成本为254美元，而辅助使用阿奇霉素预防的成本为111美元，若被证明有效，则每例剖宫产节省143美元（95%可信区间为98 - 157美元）。这些发现对众多输入因素具有稳健性；只要辅助使用阿奇霉素每1000例计划外剖宫产中能预防至少7例额外的手术部位感染，每10000例计划内剖宫产中能预防至少9例额外的手术部位感染，辅助使用阿奇霉素预防就是节省成本的。
结论
在计划内和计划外剖宫产中，辅助使用阿奇霉素预防是一种节省成本的策略。
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