Division of Pediatric Hematology-Oncology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania.
The Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, Pennsylvania.
Pediatr Blood Cancer. 2020 Oct;67(10):e28469. doi: 10.1002/pbc.28469. Epub 2020 Jul 25.
Infections are the leading cause of therapy-related mortality in pediatric patients with acute myeloid leukemia (AML). Although effectiveness of levofloxacin antibacterial prophylaxis in oncology patients is recognized, its cost-effectiveness is unknown. This study evaluated epidemiologic data regarding levofloxacin use and the cost-effectiveness of this strategy as the cost per bacteremia episode, intensive care unit (ICU) admission, and death avoided in children with AML.
A retrospective cohort study using the Pediatric Health Information System (PHIS) database compared demographic and clinical characteristics and receipt of levofloxacin prophylaxis in children with AML admitted for chemotherapy from January 1, 2014, through December 31, 2018. We then developed a decision analysis model in this population that compared costs associated with bacteremia, ICU admission, or death secondary to bacteremia to levofloxacin prophylaxis cost from a healthcare perspective. Time horizon is one chemotherapy cycle. Probabilistic and one-way sensitivity analyses evaluated model uncertainty.
Prophylaxis cost $8491 per bacteremia episode prevented compared with an average added hospital cost of $119 478. Prophylaxis cost $81 609 per ICU admission avoided, compared with an average added hospital cost of $94 181. Prophylaxis cost $220 457 per death avoided. In sensitivity analysis, at a willingness-to-pay threshold of $100 000 per bacteremia episode avoided, prophylaxis remained cost-effective in 94.6% of simulations. Prophylaxis use was more common in recent years in patients with relapsed disease and with chemotherapy regimens considered more intensive.
Prophylaxis is cost-effective in preventing bacterial infections in patients with AML. Findings support increased use in patients considered at high risk of bacterial infection secondary to myelosuppression.
感染是儿科急性髓系白血病（AML）患者治疗相关死亡的主要原因。虽然左氧氟沙星抗菌预防在肿瘤患者中的有效性已得到认可，但它的成本效益尚不清楚。本研究评估了左氧氟沙星使用的流行病学数据以及该策略的成本效益，即每避免一次菌血症发作、重症监护病房（ICU）入院和死亡的成本，在 AML 患儿中。
使用儿科健康信息系统（PHIS）数据库进行回顾性队列研究，比较了 2014 年 1 月 1 日至 2018 年 12 月 31 日期间接受化疗的 AML 患儿的人口统计学和临床特征以及左氧氟沙星预防治疗的接受情况。然后，我们在该人群中开发了一种决策分析模型，比较了从医疗保健角度来看，菌血症、ICU 入院或菌血症继发死亡与左氧氟沙星预防治疗相关的成本。时间范围为一个化疗周期。概率和单向敏感性分析评估了模型的不确定性。
预防治疗的成本为每避免一次菌血症发作 8491 美元，而平均增加的医院成本为 119478 美元。预防治疗的成本为每避免一次 ICU 入院 81609 美元，而平均增加的医院成本为 94181 美元。预防治疗的成本为每避免一次死亡 220457 美元。在敏感性分析中，在每避免一次菌血症发作的意愿支付阈值为 100000 美元的情况下，预防治疗在 94.6%的模拟中仍然具有成本效益。在最近几年，在复发疾病患者和接受被认为更强化的化疗方案的患者中，预防治疗的使用更为常见。
预防治疗在预防 AML 患者的细菌感染方面具有成本效益。研究结果支持在因骨髓抑制而有较高细菌感染风险的患者中增加预防治疗的使用。
