从德国医院管理角度出发，对 bezlotoxumab 与仅使用标准护理抗生素相比用于高复发性 CDI 风险患者的预算影响分析。
A budget impact analysis of bezlotoxumab versus standard of care antibiotics only in patients at high risk of CDI recurrence from a hospital management perspective in Germany.
机构信息
Faculty of Medicine, Department I of Internal Medicine, University of Cologne, University Hospital Cologne, Cologne, Germany.
Network Genomic Medicine, University Hospital of Cologne, Cologne, Germany.
出版信息
BMC Health Serv Res. 2021 Sep 9;21(1):939. doi: 10.1186/s12913-021-06970-8.
BACKGROUND
Clostridioides difficile infection (CDI) is one of the leading nosocomial infections, resulting in increased hospital length of stay and additional treatment costs. Bezlotoxumab, the first monoclonal antibody against CDI, has an 1 A guideline recommendation for prevention of CDI, after randomized clinical trials demonstrated its superior efficacy vs. placebo.
METHODS
The budget impact analysis at hand is focused on patients at high risk of CDI recurrence. Treatment with standard of care (SoC) + bezlotoxumab was compared with current SoC alone in the 10 most associated Diagnosis Related Groups to identify, analyze, and evaluate potential cost savings per case from the German hospital management perspective. Based on variation in days to rehospitalization, three different case consolidation scenarios were assessed: no case consolidation, case consolidation for the SoC + bezlotoxumab treatment arm only, and case consolidation for both treatment arms.
RESULTS
On average, the budget impact amounted to € 508.56 [range: € 424.85 - € 642.19] for no case consolidation, € 470.50 [range: € 378.75 - € 601.77] for case consolidation in the SoC + bezlotoxumab treatment arm, and € 618.00 [range: € 557.40 - € 758.41] for case consolidation in both treatment arms.
CONCLUSIONS
The study demonstrated administration of SoC + bezlotoxumab in patients at high risk of CDI recurrence is cost-saving from a hospital management perspective. Reduced length of stay in bezlotoxumab treated patients creates free spatial and personnel capacities for the treating hospital. Yet, a requirement for hospitals to administer bezlotoxumab is the previously made request for additional fees and a successful price negotiation.
背景
艰难梭菌感染（CDI）是一种主要的医院获得性感染，导致住院时间延长和额外的治疗费用增加。贝洛妥珠单抗是针对 CDI 的第一种单克隆抗体，在随机临床试验证明其优于安慰剂后，被 1A 指南推荐用于预防 CDI。
方法
本预算影响分析主要针对 CDI 复发风险较高的患者。将标准治疗（SoC）+贝洛妥珠单抗治疗与单独使用当前 SoC 进行比较，以确定、分析和评估从德国医院管理角度来看，每例潜在的成本节约。基于再住院天数的变化，评估了三种不同的病例整合方案：不进行病例整合、仅对 SoC+贝洛妥珠单抗治疗组进行病例整合，以及对两个治疗组都进行病例整合。
结果
平均而言，不进行病例整合的预算影响为 508.56 欧元（范围：424.85-642.19 欧元），仅对 SoC+贝洛妥珠单抗治疗组进行病例整合的预算影响为 470.50 欧元（范围：378.75-601.77 欧元），对两个治疗组都进行病例整合的预算影响为 618.00 欧元（范围：557.40-758.41 欧元）。
结论
该研究表明，从医院管理的角度来看，在 CDI 复发风险较高的患者中使用 SoC+贝洛妥珠单抗治疗具有成本节约效果。贝洛妥珠单抗治疗患者的住院时间缩短，为治疗医院创造了自由的空间和人员容量。然而，医院需要使用贝洛妥珠单抗的前提是先前提出了额外费用的要求，并成功进行了价格谈判。
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