抗艰难梭菌感染抗生素治疗的经济评价系统文献回顾。
A Systematic Literature Review of Economic Evaluations of Antibiotic Treatments for Clostridium difficile Infection.
机构信息
DRG Abacus, Bicester, UK.
Astellas Pharma Inc., 2000 Hillswood Drive, Chertsey, KT16 0RS, UK.
出版信息
Pharmacoeconomics. 2017 Nov;35(11):1123-1140. doi: 10.1007/s40273-017-0540-2.
BACKGROUND AND OBJECTIVE
Clostridium difficile infection (CDI) is associated with high management costs, particularly in recurrent cases. Fidaxomicin treatment results in lower recurrence rates than vancomycin and metronidazole, but has higher acquisition costs in Europe and the USA. This systematic literature review summarises economic evaluations (EEs) of fidaxomicin, vancomycin and metronidazole for treatment of CDI.
METHODS
Electronic databases (MEDLINE, Embase, Cochrane Library) and conference proceedings (ISPOR, ECCMID, ICAAC and IDWeek) were searched for publications reporting EEs of fidaxomicin, vancomycin and/or metronidazole in the treatment of CDI. Reference bibliographies of identified manuscripts were also reviewed. Cost-effectiveness was evaluated according to the overall population of patients with CDI, as well as in subgroups with severe CDI or recurrent CDI, or those at higher risk of recurrence or mortality.
RESULTS
Overall, 27 relevant EEs, conducted from the perspective of 12 different countries, were identified. Fidaxomicin was cost-effective versus vancomycin and/or metronidazole in 14 of 24 EEs (58.3%), vancomycin was cost-effective versus fidaxomicin and/or metronidazole in five of 27 EEs (18.5%) and metronidazole was cost-effective versus fidaxomicin and/or vancomycin in two of 13 EEs (15.4%). Fidaxomicin was cost-effective versus vancomycin in most of the EEs evaluating specific patient subgroups. Key cost-effectiveness drivers were cure rate, recurrence rate, time horizon, drug costs and length and cost of hospitalisation.
CONCLUSIONS
In most EEs, fidaxomicin was demonstrated to be cost-effective versus metronidazole and vancomycin in patients with CDI. These results have relevance to clinical practice, given the high budgetary impact of managing CDI and increasing restrictions on healthcare budgets.
OTHER
This analysis was initiated and funded by Astellas Pharma Inc.
背景与目的
艰难梭菌感染（CDI）与高昂的管理成本相关，尤其是在复发病例中。与万古霉素和甲硝唑相比，非达霉素治疗可降低复发率，但在欧洲和美国的获取成本更高。本系统文献综述总结了非达霉素、万古霉素和甲硝唑治疗 CDI 的经济评估（EE）。
方法
电子数据库（MEDLINE、Embase、Cochrane 图书馆）和会议记录（ISPOR、ECCMID、ICAAC 和 IDWeek）被搜索，以寻找报告非达霉素、万古霉素和/或甲硝唑治疗 CDI 的 EE 的出版物。还查阅了已确定手稿的参考文献。根据 CDI 患者的总体人群以及严重 CDI 或复发性 CDI 患者亚组或复发或死亡率较高的患者亚组，评估了成本效益。
结果
总体而言，从 12 个不同国家的角度共确定了 27 项相关 EE。在 24 项 EE 中的 14 项（58.3%）中，非达霉素与万古霉素和/或甲硝唑相比具有成本效益，在 27 项 EE 中的 5 项（18.5%）中，万古霉素与非达霉素和/或甲硝唑相比具有成本效益，在 13 项 EE 中的 2 项（15.4%）中，甲硝唑与非达霉素和/或甲硝唑相比具有成本效益。在评估特定患者亚组的大多数 EE 中，非达霉素与万古霉素相比具有成本效益。关键的成本效益驱动因素是治愈率、复发率、时间范围、药物成本以及住院时间和成本。
结论
在大多数 EE 中，非达霉素在 CDI 患者中被证明比甲硝唑和万古霉素更具成本效益。鉴于管理 CDI 的高预算影响以及对医疗保健预算的限制不断增加，这些结果与临床实践相关。
其他
本分析由安斯泰来制药公司发起并资助。
Zotero 插件