Psaltikidis Eliane Molina, Silva Everton Nunes da, Bustorff-Silva Joaquim Murray, Moretti Maria Luiza, Resende Mariângela Ribeiro
a Health Technology Assessment Department , Clinical Hospital of State University of Campinas , Campinas , Brazil.
b School of Medical Sciences , State University of Campinas , Campinas , Brazil.
Expert Rev Pharmacoecon Outcomes Res. 2017 Aug;17(4):355-375. doi: 10.1080/14737167.2017.1360767. Epub 2017 Aug 4.
Outpatient parenteral antimicrobial therapy (OPAT) consists of providing antimicrobial therapy by parenteral infusion without hospitalization. A systematic review was performed to compare OPAT and hospitalization as health care modalities from an economic perspective. Areas covered: We identified 1455 articles using 13 electronic databases and manual searches. Two independent reviewers identified 35 studies conducted between 1978 and 2016. We observed high heterogeneity in the following: countries, infection site, OPAT strategies and outcomes analyzed. Of these, 88% had a retrospective observational design and one was a randomized trial. With respect to economic analyses, 71% of the studies considered the cost-consequences, 11% cost minimization, 6% cost-benefit, 6% cost-utility analyses and 6% cost effectiveness. Considering all 35 studies, the general OPAT cost saving was 57.19% (from -13.03% to 95.47%). Taking into consideration only high-quality studies (6 comparative studies), the cost saving declined by 16.54% (from -13.03% to 46.86%). Expert commentary: Although most studies demonstrate that OPAT is cost-effective, the magnitude of this effect is compromised by poor methodological quality and heterogeneity. Economic assessments of the issue are needed using more rigorous methodologies that include a broad range of perspectives to identify the real magnitude of economic savings in different settings and OPAT modalities.
门诊胃肠外抗菌治疗（OPAT）是指在不住院的情况下通过胃肠外输注方式提供抗菌治疗。本研究进行了一项系统综述，旨在从经济学角度比较OPAT和住院治疗这两种医疗模式。涵盖领域：我们通过13个电子数据库检索和手工检索共识别出1455篇文章。两名独立评审员确定了1978年至2016年间开展的35项研究。我们发现以下方面存在高度异质性：国家、感染部位、OPAT策略以及所分析的结果。其中，88%的研究采用回顾性观察设计，1项为随机试验。在经济分析方面，71%的研究考虑了成本后果，11%考虑了成本最小化，6%考虑了成本效益，6%考虑了成本效用分析，6%考虑了成本效果分析。综合所有这35项研究，OPAT总体节省成本为57.19%（范围为-13.03%至95.47%）。仅考虑高质量研究（6项比较研究）时，成本节省幅度下降了16.54%（范围为-13.03%至46.86%）。专家评论：尽管大多数研究表明OPAT具有成本效益，但这种效果的程度受到方法学质量差和异质性的影响。需要采用更严格的方法对该问题进行经济评估，这些方法应涵盖广泛的视角，以确定不同环境和OPAT模式下实际的经济节省幅度。
