Buendía Jefferson Antonio, Buendia Sánchez Juan Antonio, Guerrero Patino Diana
Research group in Pharmacology and Toxicology, Department of Pharmacology and Toxicology, University of Antioquia, Medellín, Colombia.
BMC Pulm Med. 2025 Jul 22;25(1):347. doi: 10.1186/s12890-025-03797-5.
Ventilator-associated pneumonia (VAP) is a significant clinical challenge due to its morbidity, mortality, and economic burden, especially in low- and middle-income countries. This study evaluates the cost-utility of tobramycin and colistin as nebulized adjunct therapies to systemic antibiotics for managing VAP in Colombia.
A decision tree model was constructed comparing three interventions: tobramycin + systemic antibiotics, colistin + systemic antibiotics, and systemic antibiotics alone. The model used a one-year time horizon from a third-payer perspective. Clinical probabilities, costs, and utilities were sourced from literature and local databases. Sensitivity analyses (deterministic and probabilistic with 10,000 iterations) assessed uncertainty. Costs were reported in 2023 USD, adjusted by GDP deflator.
Tobramycin demonstrated the highest cost-effectiveness. Incremental QALYs were 0.06 for tobramycin and 0.02 for colistin; incremental costs were US$338.09 and US$130.63, respectively. The ICER was US$5625.86 for tobramycin and US$5422.31 for colistin. At a willingness-to-pay threshold of US$5180/QALY, tobramycin had a 56.5% probability of being cost-effective.
Tobramycin is more cost-effective than colistin as an adjunctive nebulized treatment for ventilator-associated pneumonia (VAP) in Colombia. These findings may help inform clinical guidelines and reimbursement decisions. Further research is needed to evaluate long-term outcomes and to incorporate utility data specific to the Colombian population.
呼吸机相关性肺炎（VAP）因其发病率、死亡率和经济负担，是一项重大的临床挑战，在低收入和中等收入国家尤为如此。本研究评估了妥布霉素和黏菌素作为雾化辅助疗法联合全身用抗生素治疗哥伦比亚VAP的成本效益。
构建了一个决策树模型，比较三种干预措施：妥布霉素+全身用抗生素、黏菌素+全身用抗生素以及单独使用全身用抗生素。该模型从第三方支付者的角度采用一年的时间范围。临床概率、成本和效用数据来源于文献和当地数据库。敏感性分析（确定性分析和10000次迭代的概率分析）评估不确定性。成本以2023年美元报告，并根据GDP平减指数进行调整。
妥布霉素显示出最高的成本效益。妥布霉素的增量质量调整生命年（QALY）为0.06，黏菌素为0.02；增量成本分别为338.09美元和130.63美元。妥布霉素的增量成本效果比（ICER）为5625.86美元，黏菌素为5422.31美元。在支付意愿阈值为5180美元/QALY时，妥布霉素具有成本效益的概率为56.5%。
在哥伦比亚，作为呼吸机相关性肺炎（VAP）的雾化辅助治疗，妥布霉素比黏菌素更具成本效益。这些发现可能有助于为临床指南和报销决策提供参考。需要进一步研究来评估长期结果，并纳入哥伦比亚人群特有的效用数据。
