Han Xiudi, Chen Liang, Wang Yimin, Li Hui, Wang Hong, Xing Xiqian, Zhang Chunxiao, Suo Lijun, Wang Jinxiang, Yu Guohua, Wang Guangqiang, Yao Xuexin, Yu Hongxia, Wang Lei, Liu Xuedong, Cao Bin
Department of Pulmonary and Critical Care Medicine, Qingdao Municipal Hospital Group, Qingdao City, Shandong Province, People's Republic of China.
Department of Infectious Disease, Beijing Jishuitan Hospital, Beijing, People's Republic of China.
Infect Drug Resist. 2021 May 18;14:1845-1853. doi: 10.2147/IDR.S302852. eCollection 2021.
The cost-effectiveness of different guideline-concordant antimicrobial regimens for elderly patients with community-acquired pneumonia (CAP) was rarely discussed. This study attempts to explore the most appropriate cost-effectiveness of guideline-concordant antimicrobial regimen for elderly patients with CAP in general wards.
This was a multicenter, retrospective, 4:2:1 matched study enrolling 511 elderly patients with CAP hospitalized in general wards. Two hundred ninety-two patients prescribed with β-lactam monotherapy (group A), 146 patients prescribed with fluoroquinolone monotherapy (group B) and 73 patients prescribed with β-lactam/macrolide combination therapy (group C). Clinical outcomes and medical costs were analyzed by test for categorical variables or Kruskal-Wallis -test for continuous variables.
There were no statistical differences in imaging features, etiology and complications during hospitalization among these three groups. The rates of clinical failure occurrence, in-hospital mortality, 30-day mortality and 60-day mortality also had no significant differences among group A, B and C patients; however, the median length of stay (LOS) in group A patients was 12.0 days, which was significantly higher than that in group B and C patients (both 10.0 days, p<0.02). The median total, drug, and antibiotic costs for one elderly CAP episode in group B patients were RMB 10368.4, RMB 3874.8, and RMB 1796.3, respectively, which were significantly lower than those in group A and C patients (p<0.01).
Non-inferiority of clinical failure occurrence and short-term mortality was observed in different guideline-concordant antimicrobial regimens for elderly patients with CAP in general wards; however, the median LOS and hospitalization-associated costs for one elderly CAP episode with fluoroquinolone monotherapy were significantly lowest, and this strategy was considered to be the most cost-effective strategy in general wards.
不同符合指南的抗菌治疗方案用于老年社区获得性肺炎（CAP）患者的成本效益鲜少被讨论。本研究旨在探讨普通病房中针对老年CAP患者的符合指南的抗菌治疗方案的最合适成本效益。
这是一项多中心、回顾性、4:2:1匹配研究，纳入了511例在普通病房住院的老年CAP患者。292例患者接受β-内酰胺单药治疗（A组），146例患者接受氟喹诺酮单药治疗（B组），73例患者接受β-内酰胺/大环内酯联合治疗（C组）。通过分类变量的卡方检验或连续变量的Kruskal-Wallis检验分析临床结局和医疗费用。
这三组患者在住院期间的影像学特征、病因及并发症方面无统计学差异。A、B、C组患者的临床失败发生率、住院死亡率、30天死亡率和60天死亡率也无显著差异；然而，A组患者的中位住院时间（LOS）为12.0天，显著高于B组和C组患者（均为10.0天，p<0.02）。B组患者每例老年CAP发作的中位总费用、药物费用和抗生素费用分别为10368.4元、3874.8元和1796.3元，显著低于A组和C组患者（p<0.01）。
普通病房中针对老年CAP患者的不同符合指南的抗菌治疗方案在临床失败发生率和短期死亡率方面具有非劣效性；然而，氟喹诺酮单药治疗的老年CAP发作的中位LOS和住院相关费用显著最低，该策略被认为是普通病房中最具成本效益的策略。
