在阿联酋住院的 COVID-19 患者中使用抗病毒疗法：成本效益和医疗资源使用分析。
Use of anti-viral therapies in hospitalised COVID-19 patients in the United Arab Emirates: a cost-effectiveness and health-care resource use analysis.
机构信息
Al-Qassimi Hospital Sharjah, Sharjah, United Arab Emirates.
Ministry of Health and Prevention, Dubai, United Arab Emirates.
出版信息
BMC Health Serv Res. 2023 Apr 20;23(1):383. doi: 10.1186/s12913-023-09376-w.
BACKGROUND
This study attempts to estimate the cost-effectiveness of the antiviral remdesivir, as recommended in the 2021 COVID treatment guidelines for the United Arab Emirates, compared to standard of care (SOC), but also favipiravir (FAVI), which was also recommended for the treatment of hospitalized COVID patients.
METHODS
A cost-effectiveness model was built using published efficacy data for RDV, FAVI and SOC as well as local epidemiology data. The outcomes measured included hospital bed days averted, mortality, costs and cost per outcome over one year. One-way, probabilistic and scenario analyses were undertaken to reflect uncertainty in the estimates.
RESULTS
When modelled over one year, the results indicated that treatment of adults in need of supplemental oxygen with RDV + SOC could result in 11,338 fewer general ward bed days, 7,003 fewer ICU days and 5,451 fewer ICU + MIV bed days compared to SOC alone and similar results when compared with FAVI + SOC. The model results also showed that there were 374 fewer deaths associated with the use of RDV + SOC compared to SOC alone. The model also estimates substantial potential cost-savings associated with RDV + SOC treatment compared with SOC alone (USD 3,454 per patient). The results of the one-way sensitivity analysis showed that the model was sensitive to estimates of length of stay and the cost of hospitalization. Despite this, the model predicted cost-savings in all scenarios versus all comparators.
CONCLUSIONS
The model estimated that using RDV + SOC could result in substantial reductions in HCRU and cost savings regardless of the comparator. However, it should be noted that reliable clinical information on FAVI was limited therefore it is challenging to interpret these results. All the potential benefits modelled here for RDV + SOC can have implications not only for the health of the UAE population but for improving hospital capacity to deal with other conditions.
背景
本研究旨在评估 2021 年阿联酋 COVID 治疗指南推荐的抗病毒药物瑞德西韦（remdesivir）相较于标准治疗（SOC），以及同样被推荐用于治疗住院 COVID 患者的法匹拉韦（favipiravir，FAVI）的成本效益。
方法
本研究使用瑞德西韦、法匹拉韦和 SOC 的已发表疗效数据以及当地流行病学数据，建立了成本效益模型。测量的结果包括避免的住院床位天数、死亡率、成本和一年的成本效益。进行了单因素、概率和情景分析，以反映估计的不确定性。
结果
在一年的模型中，结果表明，与 SOC 相比，用瑞德西韦联合 SOC 治疗需要补充氧气的成年人可使普通病房床位减少 11338 天，ICU 床位减少 7003 天，ICU+MIV 床位减少 5451 天；与 FAVI 联合 SOC 相比，也有类似的结果。模型结果还表明，与 SOC 相比，瑞德西韦联合 SOC 治疗可使死亡人数减少 374 人。该模型还估计，与 SOC 相比，瑞德西韦联合 SOC 治疗可节省大量潜在成本（每位患者 3454 美元）。单因素敏感性分析结果表明，该模型对住院时间和住院费用的估计较为敏感。尽管如此，该模型预测在所有情况下与所有对照相比均能节省成本。
结论
该模型估计，无论与哪种药物比较，使用瑞德西韦联合 SOC 均可显著减少 HCRU 和节省成本。然而，应注意的是，关于法匹拉韦的可靠临床信息有限，因此难以解释这些结果。这里为瑞德西韦联合 SOC 建模的所有潜在获益不仅对阿联酋人口的健康具有重要意义，而且对提高医院处理其他疾病的能力也具有重要意义。
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