From the Department of Neurology, Amsterdam Neuroscience (W.F.W., J.-D.V., P.J.N., D.v.d.B.), and Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center/Clinical Research Unit (M.G.W.D.), Academic Medical Center, University of Amsterdam; and Department of Neurology (E.Z., H.K.), Albert Schweitzer Hospital, Dordrecht, Netherlands.
Neurology. 2018 May 1;90(18):e1553-e1560. doi: 10.1212/WNL.0000000000005412. Epub 2018 Apr 6.
To evaluate the cost-effectiveness of preventive ceftriaxone vs standard stroke unit care without preventive antimicrobial therapy in acute stroke patients.
In this multicenter, randomized, open-label trial with masked endpoint assessment, 2,550 patients with acute stroke were included between 2010 and 2014. Economic evaluation was performed from a societal perspective with a time horizon of 3 months. Volumes and costs of direct, indirect, medical, and nonmedical care were assessed. Primary outcome was cost per unit of the modified Rankin Scale (mRS) and per quality-adjusted life year (QALY) for cost-effectiveness and cost-utility analysis. Incremental cost-effectiveness analyses were performed.
A total of 2,538 patients were available for the intention-to-treat analysis. For the cost-effectiveness analysis, 2,538 patients were available for in-hospital resource use and 1,453 for other resource use. Use of institutional care resources, out-of-pocket expenses, and productivity losses was comparable between treatment groups. The mean score on mRS was 2.38 (95% confidence interval [CI] 2.31-2.44) vs 2.44 (95% CI 2.37-2.51) in the ceftriaxone vs control group, the decrease by 0.06 (95% CI -0.04 to 0.16) in favor of ceftriaxone treatment being nonsignificant. However, the number of QALYs was 0.163 (95% CI 0.159-0.166) vs 0.155 (95% CI 0.152-0.158) in the ceftriaxone vs control group, with the difference of 0.008 (95% CI 0.003-0.012) in favor of ceftriaxone ( = 0.006) at 3 months. The probability of ceftriaxone being cost-effective ranged between 0.67 and 0.89. Probability of 0.75 was attained at a willing-to-pay level of €2,290 per unit decrease in the mRS score and of €12,200 per QALY.
Preventive ceftriaxone has a probability of 0.7 of being less costly than standard treatment per unit decrease in mRS and per QALY gained.
评估急性脑卒中患者中使用头孢曲松预防与不使用预防抗菌治疗的标准卒中单元护理相比的成本效益。
在这项 2010 年至 2014 年间进行的多中心、随机、开放性标记终点评估的试验中，纳入了 2550 名急性脑卒中患者。从社会角度进行经济评估，时间范围为 3 个月。评估了直接、间接、医疗和非医疗护理的量和成本。主要结局是改良 Rankin 量表（mRS）每单位和每质量调整生命年（QALY）的成本效益和成本效用分析。进行了增量成本效益分析。
共有 2538 名患者可用于意向治疗分析。对于成本效益分析，2538 名患者可用于住院资源使用，1453 名患者可用于其他资源使用。两组治疗组的机构护理资源使用、自付费用和生产力损失相当。头孢曲松组的 mRS 平均得分为 2.38（95%置信区间 [CI] 2.31-2.44），对照组为 2.44（95% CI 2.37-2.51），头孢曲松组降低 0.06（95% CI -0.04 至 0.16），差异无统计学意义。然而，头孢曲松组的 QALY 数为 0.163（95% CI 0.159-0.166），对照组为 0.155（95% CI 0.152-0.158），头孢曲松组的差异为 0.008（95% CI 0.003-0.012），有利于头孢曲松（=0.006），在 3 个月时。头孢曲松具有成本效益的概率在 0.67 到 0.89 之间。在 mRS 评分每降低 1 单位的意愿支付水平为 2290 欧元，QALY 每增加 12200 欧元的情况下，达到 0.75 的概率。
预防使用头孢曲松的成本效益比标准治疗每降低 mRS 单位和每增加 QALY 的成本低 0.7 的概率为 0.7。
