黎巴嫩抗菌药物耐药性的医疗保健成本：来自支付方视角的多中心前瞻性队列研究。
The healthcare costs of antimicrobial resistance in Lebanon: a multi-centre prospective cohort study from the payer perspective.
机构信息
Department of Mathématiques Informatique et Télécommunications, Université Toulouse III, Paul Sabatier, INSERM, UMR 1295, F-31000, Toulouse, France.
INSPECT-LB: Institut National de Santé Publique, d'Épidémiologie Clinique et de Toxicologie-Liban, Beirut, Lebanon.
出版信息
BMC Infect Dis. 2021 May 1;21(1):404. doi: 10.1186/s12879-021-06084-w.
BACKGROUND
Our aim was to examine whether the length of stay, hospital charges and in-hospital mortality attributable to healthcare- and community-associated infections due to antimicrobial-resistant bacteria were higher compared with those due to susceptible bacteria in the Lebanese healthcare settings using different methodology of analysis from the payer perspective .
METHODS
We performed a multi-centre prospective cohort study in ten hospitals across Lebanon. The sample size consisted of 1289 patients with documented healthcare-associated infection (HAI) or community-associated infection (CAI). We conducted three separate analysis to adjust for confounders and time-dependent bias: (1) Post-HAIs in which we included the excess LOS and hospital charges incurred after infection and (2) Matched cohort, in which we matched the patients based on propensity score estimates (3) The conventional method, in which we considered the entire hospital stay and allocated charges attributable to CAI. The linear regression models accounted for multiple confounders.
RESULTS
HAIs and CAIs with resistant versus susceptible bacteria were associated with a significant excess length of hospital stay (2.69 days [95% CI,1.5-3.9]; p < 0.001) and (2.2 days [95% CI,1.2-3.3]; p < 0.001) and resulted in additional hospital charges ($1807 [95% CI, 1046-2569]; p < 0.001) and ($889 [95% CI, 378-1400]; p = 0.001) respectively. Compared with the post-HAIs analysis, the matched cohort method showed a reduction by 26 and 13% in hospital charges and LOS estimates respectively. Infections with resistant bacteria did not decrease the time to in-hospital mortality, for both healthcare- or community-associated infections. Resistant cases in the post-HAIs analysis showed a significantly higher risk of in-hospital mortality (odds ratio, 0.517 [95% CI, 0.327-0.820]; p = 0.05).
CONCLUSION
This is the first nationwide study that quantifies the healthcare costs of antimicrobial resistance in Lebanon. For cases with HAIs, matched cohort analysis showed more conservative estimates compared with post-HAIs method. The differences in estimates highlight the need for a unified methodology to estimate the burden of antimicrobial resistance in order to accurately advise health policy makers and prioritize resources expenditure.
背景
本研究旨在从支付方角度，采用不同分析方法，在黎巴嫩医疗保健环境中，比较抗菌药物耐药菌引起的与医疗保健相关感染（HAI）和社区获得性感染（CAI）与敏感菌引起的感染之间的住院时间、住院费用和院内死亡率。
方法
我们在黎巴嫩的 10 家医院进行了一项多中心前瞻性队列研究。样本量包括 1289 例有明确的 HAI 或 CAI 患者。我们进行了 3 项单独的分析以调整混杂因素和时间依赖性偏倚：（1）HAI 后分析，纳入感染后发生的额外住院时间（LOS）和住院费用；（2）匹配队列分析，基于倾向评分估计进行匹配；（3）传统方法，考虑整个住院时间并分配归因于 CAI 的费用。线性回归模型考虑了多个混杂因素。
结果
与敏感菌相比，耐药菌引起的 HAI 和 CAI 与显著的住院时间延长（2.69 天[95%CI，1.5-3.9]；p<0.001）和（2.2 天[95%CI，1.2-3.3]；p<0.001）和额外的住院费用（$1807[95%CI，1046-2569]；p<0.001）和（$889[95%CI，378-1400]；p=0.001）相关。与 HAI 后分析相比，匹配队列方法使住院费用和 LOS 估计值分别降低了 26%和 13%。耐药菌感染并未降低 HAI 和 CAI 相关感染的院内死亡率发生时间。在 HAI 后分析中，耐药病例的院内死亡率风险显著更高（比值比，0.517[95%CI，0.327-0.820]；p=0.05）。
结论
这是第一项量化黎巴嫩抗菌药物耐药性对医疗保健成本影响的全国性研究。对于 HAI 患者，匹配队列分析与 HAI 后分析相比，估计结果更为保守。估计值的差异突出表明需要采用统一的方法来估计抗菌药物耐药性的负担，以便为卫生政策制定者提供准确的建议并优先考虑资源支出。
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