巴西国家卫生系统中门诊肠外抗菌治疗（OPAT）的成本-效用分析。
Cost-utility analysis of outpatient parenteral antimicrobial therapy (OPAT) in the Brazilian national health system.
机构信息
a Hospital Epidemiology Department and Health Technology Assessment Department , Clinical Hospital of State University of Campinas , Campinas , Brazil.
b School of Medical Sciences , State University of Campinas , Campinas , Brazil.
出版信息
Expert Rev Pharmacoecon Outcomes Res. 2019 Jun;19(3):341-352. doi: 10.1080/14737167.2019.1541404. Epub 2018 Nov 5.
BACKGROUND
Outpatient parenteral antimicrobial therapy (OPAT) has been used for decades in different countries to reduce hospitalization rates, with favorable clinical and economic outcomes. This study assesses the cost-utility of OPAT compared to inpatient parenteral antimicrobial therapy (IPAT) from the perspective of a public university hospital and the Brazilian National Health System (Unified Health System -SUS).
METHODS
Prospective study with adult patients undergoing OPAT at an infusion center, compared to IPAT. Clinical outcomes and quality-adjusted life year (QALY) were assessed, as well as a micro-costing. Cost-utility analysis from the hospital and SUS perspectives were conducted by means of a decision tree, within a 30-day horizon time.
RESULTS
Forty cases of OPAT (1112 days) were included and monitored, with a favorable outcome in 97.50%. OPAT compared to IPAT generated overall savings of 31.86% from the hospital perspective and 26.53% from the SUS perspective. The intervention reduced costs, with an incremental cost-utility ratio of -44,395.68/QALY for the hospital and -48,466.70/QALY for the SUS, with better cost-utility for treatment times greater than 14 days. Sensitivity analysis confirmed the stability of the model.
CONCLUSION
Our economic assessment demonstrated that, in the Brazilian context, OPAT is a cost-saving strategy both for hospitals and for the SUS.
背景
在不同国家，门诊患者的肠外抗菌治疗（OPAT）已经使用了几十年，以降低住院率，取得了良好的临床和经济效果。本研究从公立大学附属医院和巴西国家卫生系统（统一卫生系统-SUS）的角度评估了 OPAT 与住院患者的肠外抗菌治疗（IPAT）相比的成本效益。
方法
前瞻性研究，在输液中心对接受 OPAT 的成年患者与 IPAT 进行比较。评估了临床结果和质量调整生命年（QALY），并进行了微观成本核算。通过决策树，在 30 天的时间内，从医院和 SUS 的角度进行成本效益分析。
结果
纳入并监测了 40 例 OPAT（1112 天）病例，其中 97.50%的病例结果良好。与 IPAT 相比，OPAT 从医院的角度来看，总体节省了 31.86%，从 SUS 的角度来看，节省了 26.53%。该干预措施降低了成本，医院的增量成本效益比为-44395.68/QALY，SUS 的增量成本效益比为-48466.70/QALY，治疗时间大于 14 天的成本效益更好。敏感性分析证实了模型的稳定性。
结论
我们的经济评估表明，在巴西背景下，OPAT 是一种既能为医院又能为 SUS 节省成本的策略。
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