Torres Antoni, Soriano Alex, Rivolo Simone, Remak Edit, Peral Carmen, Kantecki Michal, Ansari Wajeeha, Charbonneau Claudie, Hammond Jennifer, Grau Santiago, Wilcox Mark
Servei de Pneumologia Hospital Clinic, University of Barcelona, IDIPAPS, CIBERES, ICREA, Barcelona, Spain.
Hospital Clínic of Barcelona,University of Barcelona, IDIBAPS, Barcelona, Spain.
Clinicoecon Outcomes Res. 2022 Mar 18;14:149-161. doi: 10.2147/CEOR.S329494. eCollection 2022.
Complicated skin and soft tissue infections (cSSTI) are associated with high healthcare resource use and costs. The emergency nature of cSSTI hospitalizations requires starting immediate empiric intravenous (IV) antibiotic treatment, making the appropriate choice of initial antibiotic therapy crucial.
The use of ceftaroline fosamil (CFT) as an alternative to other IV antibiotic therapies for the empiric treatment of hospitalized adults with cSSTI (vancomycin, linezolid, daptomycin, cloxacillin, tedizolid) was evaluated through cost consequences analysis. The model structure was a decision tree accounting for four different pathways: patients demonstrating early response (ER) either discharged early (with oral antibiotic) or remaining in hospital to continue the initial therapy; non-responders either remaining on the initial IV therapy or switching to a second-line antibiotic. The model perspective was the Spanish National Health System.
CFT resulted in average percentage of patients discharged early (PDE) of 24.6% (CI 19.49-30.2%) with average total cost per patient of €6763 (€6268-€7219). Vancomycin, linezolid, daptomycin and tedizolid resulted in average PDE of 22% (17.34-27.09%), 26.4% (20.5-32.32%), 28.6% (22.08-35.79%) and 26.5% (20.39-33.25%), respectively, for a total cost per patient of €6,619 (€5,902-€6,929), €6,394 (€5,881-€6,904), €6,855 (€5,800-€7,410) and €7,173 (€6,608-€7,763), respectively. Key model drivers were ER and antibiotic treatment duration, with hospital costs accounting for over 83% of the total expenditures.
Given its clinical and safety profile, CFT is an acceptable choice for cSSTI empiric therapy providing comparable ER and costs to other relevant antibiotic options.
复杂皮肤及软组织感染(cSSTI)与大量医疗资源的使用及高额费用相关。cSSTI住院的紧急性要求立即开始经验性静脉注射(IV)抗生素治疗,因此选择合适的初始抗生素治疗至关重要。
通过成本后果分析,评估了头孢洛林酯(CFT)作为其他IV抗生素疗法的替代药物,用于经验性治疗cSSTI住院成人患者(万古霉素、利奈唑胺、达托霉素、氯唑西林、替地唑胺)的情况。模型结构为决策树,考虑了四种不同路径:表现出早期反应(ER)的患者要么提前出院(使用口服抗生素),要么留在医院继续初始治疗;无反应者要么继续初始IV治疗,要么换用二线抗生素。模型视角为西班牙国家卫生系统。
CFT治疗的患者早期出院平均百分比(PDE)为24.6%(可信区间19.49 - 30.2%),每位患者的平均总成本为6763欧元(6268 - 7219欧元)。万古霉素、利奈唑胺、达托霉素和替地唑胺治疗的患者平均PDE分别为22%(17.34 - 27.09%)、26.4%(20.5 - 32.32%)、28.6%(22.08 - 35.79%)和26.5%(20.39 - 33.25%),每位患者的总成本分别为6619欧元(5902 - 6929欧元)、6394欧元(5881 - 6904欧元)、6855欧元(5800 - 7410欧元)和7173欧元(6608 - 7763欧元)。关键模型驱动因素为ER和抗生素治疗持续时间,医院成本占总支出的83%以上。
鉴于其临床和安全性特征,CFT是cSSTI经验性治疗的可接受选择,其ER和成本与其他相关抗生素选择相当。