基于重症监护病房的快速综合征聚合酶链反应在医院获得性肺炎中的成本效益：INHALE WP3多中心随机对照试验分析

Cost-effectiveness of rapid, ICU-based, syndromic PCR in hospital-acquired pneumonia: analysis of the INHALE WP3 multi-centre RCT.

作者信息

Wagner Adam P, Enne Virvel, Gant Vanya, Stirling Susan, Barber Julie A, Livermore David M, Turner David A

机构信息

Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, UK.

National Institute for Health and Care Research Applied Research Collaboration East of England (NIHR ARC EoE), Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK.

出版信息

Crit Care. 2025 Aug 8;29(1):352. doi: 10.1186/s13054-025-05428-1.

DOI:10.1186/s13054-025-05428-1

PMID:40781331

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12333181/

Abstract

BACKGROUND

Hospital-acquired and ventilator-associated pneumonia (HAP and VAP) are pneumonias arising > 48 h after admission or intubation respectively. Conventionally, HAP/VAP patients are given broad-spectrum empiric antibiotics at clinical diagnosis, refined after 48-72 h, once microbiology results become available. Molecular tests offer swifter results, potentially improving patient care. To investigate whether this potential is realisable, we conducted a pragmatic multi-centre RCT ('INHALE WP3') of rapid, syndromic polymerase chain reaction (PCR) in ICU HAP/VAP compared with standard of care. As the use of molecular tests impact on hospital resources, it is important to consider their potential value-for-money to make fully informed decisions. Consequently, INHALE WP3 included an economic evaluation, presented here. Its aim was to estimate the cost-effectiveness of an in-ICU PCR (bioMérieux BioFire FilmArray Pneumonia Panel) in HAP/VAP, informing whether to implement such technology in routine NHS care.

METHODS

We collected data on patient resource use and costs. These data were combined with INHALE WP3's two primary outcome measures: antibiotic stewardship at 24 h and clinical cure at 14 days. Cost-effectiveness analyses were carried out using regression models adjusting for site. Sensitivity analyses explored assumptions and sub-group analyses explored differential impacts.

RESULTS

We found lower total ICU costs (including PCR costs) in the intervention (PCR-guided therapy) group. Average costs were £40,951 for standard of care compared with £33,149 for the intervention group, a difference of - £7,802 (95% CI: - £15,696, £92). For antibiotic stewardship, the PCR-guided therapy was both less costly and more effective than routine patient management. For clinical cure, we did not find PCR-guided therapy to be cost-effective due to fewer cases being cured in the intervention group.

CONCLUSIONS

We found lower average ICU costs with the Pneumonia Panel. The pneumonia panel was cost-effective in terms of antibiotic stewardship, but not clinical cure.

TRIAL REGISTRATION

Registered as ISRCTN16483855 on 5th August 2019.

摘要

背景

医院获得性肺炎和呼吸机相关性肺炎（HAP和VAP）分别是指入院或插管48小时后发生的肺炎。按照惯例，HAP/VAP患者在临床诊断时给予广谱经验性抗生素治疗，待48 - 72小时后微生物学结果出来后再进行调整。分子检测能更快得出结果，可能改善患者治疗。为研究这种潜力是否能够实现，我们进行了一项务实的多中心随机对照试验（“INHALE WP3”），比较在ICU中针对HAP/VAP采用快速症状性聚合酶链反应（PCR）与标准治疗的效果。由于分子检测的使用会影响医院资源，因此重要的是考虑其潜在的性价比，以便做出充分知情的决策。因此，INHALE WP3纳入了一项经济评估，在此呈现。其目的是估计ICU内PCR（生物梅里埃公司的BioFire FilmArray肺炎检测板）在HAP/VAP中的成本效益，为是否在英国国家医疗服务体系（NHS）的常规护理中采用该技术提供依据。

方法

我们收集了患者资源使用和成本的数据。这些数据与INHALE WP3的两个主要结局指标相结合：24小时时的抗生素管理和14天时的临床治愈情况。使用针对不同地点进行调整的回归模型进行成本效益分析。敏感性分析探讨了假设，亚组分析探讨了不同影响。

结果

我们发现干预组（PCR引导治疗）的ICU总成本较低（包括PCR成本）。标准治疗的平均成本为40,951英镑，而干预组为33,149英镑，相差 - 7,802英镑（95%置信区间：- 15,696英镑，92英镑）。对于抗生素管理，PCR引导治疗比常规患者管理成本更低且更有效。对于临床治愈，由于干预组治愈的病例较少，我们未发现PCR引导治疗具有成本效益。