Department of Science and Education of the Fourth Affiliated Hospital and School of Public Health, Center for Health Policy Studies, Zhejiang University School of Medicine, Hangzhou, China.
Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine (NHC Key Laboratory of Health Economics and Policy Research), Shandong University, Jinan, China.
BMJ Open. 2024 Aug 29;14(8):e086039. doi: 10.1136/bmjopen-2024-086039.
This analysis aims to better reflect the value of new antibiotic treatment strategies, thereby informing clinical antibiotic use, antimicrobial reimbursement and/or hospital formulary decision-making in China.
We adapted a published and validated dynamic disease transmission and cost-effectiveness model to evaluate the clinical and economic outcomes of introducing a new antibiotic, ceftazidime/avibactam (CAZ-AVI) for treating resistant infections in Zhejiang province, China. Outcomes were assessed over a 10-year infectious period and an annual discount rate of 5%. Costs were extracted from the hospital's Health Information System (HIS) and obtained after data cleaning, aggregation and discounting.
The Chinese healthcare system perspective.
10 905 patients in a Chinese tier-3 hospital from 2018 to 2021 with any of the three common infections (complicated intra-abdominal infection (cIAI), hospital-acquired/ventilator-associated pneumonia (HAP/VAP) and infections with limited treatment options (LTO)) caused by three common resistant pathogens ( spp. ).
(1) Current treatment strategy (piperacillin-tazobactam (pip/taz) and meropenem); (2) CAZ-AVI at the third line; (3) CAZ-AVI at the second line; (4) CAZ-AVI at the first line; (5) CAZ/AVI first line, two lines diversified (i.e., equal pip/taz and CAZ-AVI at the first line; meropenem at the last line) and (6) CAZ/AVI first line, all-lines diversified.
Quality-adjusted life years (QALYs) lost, hospitalisation costs and incremental net monetary benefit (INMB) were used to assess cost-effectiveness.
Over 10 years, the introduction of CAZ-AVI to the current treatment strategy led to lower hospitalisation costs and more QALYs across all five treatment strategies, with between 68 284 and 78 571 QALYs gained whilst saving up to US$236.37 for each additional QALY gained. The INMB of introducing CAZ-AVI is estimated up to US$3 550 811 878.
Introducing CAZ-AVI had a positive impact on clinical and economic outcomes for treating antimicrobial resistance, and diversifying the antibiotics use early in the treatment might yield the best benefits.
本分析旨在更好地体现新型抗生素治疗策略的价值，从而为中国的临床抗生素使用、抗菌药物报销和/或医院处方集决策提供信息。
我们改编了已发表和验证的动态疾病传播和成本效益模型，以评估在中国浙江省引入新型抗生素头孢他啶/阿维巴坦（CAZ-AVI）治疗耐药感染的临床和经济结果。结果在 10 年的感染期和每年 5%的折扣率下进行评估。成本从医院的健康信息系统（HIS）中提取，并在数据清理、聚合和贴现后获得。
中国医疗保健系统视角。
2018 年至 2021 年期间，中国三级医院的 10905 名患者患有三种常见感染（复杂性腹腔内感染（cIAI）、医院获得性/呼吸机相关性肺炎（HAP/VAP）和治疗选择有限的感染（LTO））由三种常见耐药病原体（ spp.）引起。
（1）当前治疗策略（哌拉西林-他唑巴坦（pip/taz）和美罗培南）；（2）三线 CAZ-AVI；（3）二线 CAZ-AVI；（4）一线 CAZ-AVI；（5）一线 CAZ/AVI，二线多样化（即 pip/taz 和 CAZ-AVI 一线相等；美罗培南最后一线）；（6）一线 CAZ/AVI，全线多样化。
使用失能调整生命年（QALYs）和住院费用及增量净货币收益（INMB）来评估成本效益。
在 10 年期间，将 CAZ-AVI 引入当前治疗策略可降低所有五种治疗策略的住院费用和 QALYs，每个额外 QALY 可节省高达 236.37 美元。引入 CAZ-AVI 的 INMB 估计高达 35.51 亿美元。
引入 CAZ-AVI 对抗菌药物耐药性的临床和经济结果有积极影响，早期在治疗中多样化使用抗生素可能会带来最佳效益。
