早期 COVID-19 治疗试验：与住院时间、死亡率和相关费用的关系。

Early experimental COVID-19 therapies: associations with length of hospital stay, mortality and related costs.

机构信息

Medical Directorate, Finance Directorate, Geneva University Hospitals, Geneva University, Switzerland.

Division of General Internal Medicine and Division of Clinical Epidemiology, University Hospitals of Geneva, Switzerland / Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.

出版信息

Swiss Med Wkly. 2020 Dec 31;150:w20446. doi: 10.4414/smw.2020.20446. eCollection 2020 Dec 14.

DOI:10.4414/smw.2020.20446

PMID:33382449

Abstract

AIMS OF THE STUDY

Hydroxychloroquine and lopinavir/ritonavir have been used as experimental therapies to treat COVID-19 during the first wave of the pandemic. Randomised controlled trials have recently shown that there are no meaningful benefits of these two therapies in hospitalised patients. Uncertainty remains regarding the potential harmful impact of these therapies as very early treatments and their burden to the health care system. The present study investigated the length of hospital stay (LOS), mortality, and costs of hydroxychloroquine, lopinavir/ritonavir or their combination in comparison with standard of care among patients hospitalised for coronavirus disease 2019 (COVID-19).

METHODS

This retrospective observational cohort study took place in the Geneva University Hospitals, Geneva, Switzerland (n = 840) between 26 February and 31 May 2020. Demographics, treatment regimens, comorbidities, the modified National Early Warning Score (mNEWS) on admission, and contraindications to COVID-19 treatment options were assessed. Outcomes included LOS, in-hospital mortality, and drug and LOS costs.

RESULTS

After successful propensity score matching, patients treated with (1) hydroxychloroquine, (2) lopinavir/ritonavir or (3) their combination had on average 3.75 additional hospitalisation days (95% confidence interval [CI] 1.37–6.12, p = 0.002), 1.23 additional hospitalisation days (95% CI −1.24 – 3.51, p = 0.319), and 4.19 additional hospitalisation days (95% CI 1.52–5.31, p <0.001), respectively, compared with patients treated with the standard of care. Neither experimental therapy was significantly associated with mortality. These additional hospital days amounted to 1010.77 additional days for hydroxychloroquine and hydroxychloroquine combined with lopinavir/ritonavir, resulting in an additional cost of US$ 2,492,214 (95%CI US$ 916,839–3,450,619).

CONCLUSIONS

Prescribing experimental therapies for COVID-19 was not associated with a reduced LOS and might have increased the pressure put on healthcare systems.

摘要

研究目的

在大流行的第一波期间，羟氯喹和洛匹那韦/利托那韦已被用作治疗 COVID-19 的实验性疗法。最近的随机对照试验表明，这两种疗法对住院患者没有明显的益处。对于这些疗法作为早期治疗的潜在有害影响及其对医疗保健系统的负担，仍存在不确定性。本研究调查了与 COVID-19 住院患者的标准治疗相比，羟氯喹、洛匹那韦/利托那韦或其联合治疗的住院时间（LOS）、死亡率和成本。

方法

本回顾性观察性队列研究于 2020 年 2 月 26 日至 5 月 31 日在瑞士日内瓦大学附属医院进行（n=840）。评估了人口统计学、治疗方案、合并症、入院时改良的国家早期预警评分（mNEWS）和 COVID-19 治疗方案的禁忌症。结局包括 LOS、院内死亡率以及药物和 LOS 成本。

结果

在成功进行倾向评分匹配后，接受（1）羟氯喹、（2）洛匹那韦/利托那韦或（3）其联合治疗的患者平均住院时间增加了 3.75 天（95%置信区间[CI] 1.37–6.12，p=0.002）、1.23 天（95%CI-1.24–3.51，p=0.319）和 4.19 天（95%CI 1.52–5.31，p <0.001），与接受标准治疗的患者相比。两种实验性疗法均与死亡率无显著相关性。羟氯喹和羟氯喹联合洛匹那韦/利托那韦的额外住院天数分别为 1010.77 天，导致额外费用为 2492214 美元（95%CI 916839–3450619 美元）。