英国单纯疱疹病毒性脑炎早期治疗与延迟治疗的健康经济影响

Health economic impact of early versus delayed treatment of herpes simplex virus encephalitis in the UK.

作者信息

Defres Sylviane, Navvuga Patricia, Moore Shona, Hardwick Hayley, Easton Ava, Michael Benedict Daniel, Kneen Rachel, Griffiths Michael, Medina-Lara Antonieta, Solomon Tom

机构信息

Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK

Tropical and Infectious Disease Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK.

出版信息

BMJ Open. 2025 Sep 18;15(9):e088473. doi: 10.1136/bmjopen-2024-088473.

DOI:10.1136/bmjopen-2024-088473

PMID:40973386

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12458707/

Abstract

OBJECTIVE

Thanks to the introduction of recent national guidelines for treating herpes simplex virus (HSV) encephalitis, health outcomes have improved. This paper evaluates the health system costs and the health-related quality of life implications of these guidelines.

DESIGN AND SETTING

A sub-analysis of data from a prospective, multi-centre, observational cohort ENCEPH-UK study conducted across 29 hospitals in the UK from 2012 to 2015.

STUDY PARTICIPANTS

Data for patients aged ≥16 years with a confirmed HSV encephalitis diagnosis admitted for treatment with aciclovir were collected at discharge, 3 and 12 months.

PRIMARY AND SECONDARY OUTCOME MEASURES

Patient health outcomes were measured by the Glasgow outcome score (GOS), modified ranking score (mRS) and the EuroQoL; healthcare costs were estimated per patient at discharge from hospital and at 12 months follow-up. In addition, Quality Adjusted Life Years (QALYs) were calculated from the EQ-5D utility scores. Cost-utility analysis was performed using the NHS and Social Care perspective.

RESULTS

A total of 49 patients were included; 35 were treated within 48 hours, 'early' (median (IQR) 8.25 [3.7-20.5]) and 14 were treated after 48 hours 'delayed' (median (IQR) 93.9 [66.7-100.1]). At discharge, 30 (86%) in the early treatment group had a good mRS outcome score (0-3) compared with 4 (29%) in the delayed group. According to GOS, 10 (29%) had a good recovery in the early treatment group, but only 1 (7%) in the delayed group. EQ-5D-3L utility value at discharge was significantly higher for early treatment (0.609 vs 0.221, p<0.000). After adjusting for age and symptom duration at admission, early treatment incurred a lower average cost at discharge, £23,086 (95% CI: £15,186 to £30,987) vs £42,405 (95% CI: £25,457 to £59,354) [p<0.04]. A -£20,218 (95% CI: -£52,173 to £11,783) cost difference was observed at the 12- month follow-up post discharge.

CONCLUSIONS

This study suggests that early treatment may be associated with better health outcomes and reduced patient healthcare costs, with a potential for savings to the NHS with faster treatment.

摘要

目的

由于近期国家出台了治疗单纯疱疹病毒（HSV）脑炎的指南，健康状况得到了改善。本文评估了这些指南对卫生系统成本以及与健康相关的生活质量的影响。

设计与背景

对2012年至2015年在英国29家医院进行的一项前瞻性、多中心、观察性队列ENCEPH-UK研究的数据进行子分析。

研究参与者

收集了年龄≥16岁、确诊为HSV脑炎且接受阿昔洛韦治疗的患者在出院时、3个月和12个月时的数据。

主要和次要结局指标

通过格拉斯哥结局评分（GOS）、改良Rankin评分（mRS）和欧洲生活质量量表（EuroQoL）来衡量患者的健康状况；估算每位患者出院时和随访12个月时的医疗费用。此外，根据EQ-5D效用评分计算质量调整生命年（QALY）。从英国国民医疗服务体系（NHS）和社会护理的角度进行成本-效用分析。

结果

共纳入49例患者；35例在48小时内接受“早期”治疗（中位数（四分位间距）8.25 [3.7 - 20.5]），14例在48小时后接受“延迟”治疗（中位数（四分位间距）93.9 [66.7 - 100.1]）。出院时，早期治疗组30例（86%）的mRS结局评分良好（0 - 3），而延迟治疗组为4例（29%）。根据GOS，早期治疗组10例（29%）恢复良好，而延迟治疗组仅1例（7%）。早期治疗出院时的EQ-5D-3L效用值显著更高（0.609对0.221，p<0.000）。在对年龄和入院时症状持续时间进行调整后，早期治疗出院时的平均成本较低，为23,086英镑（95%置信区间：15,186英镑至30,987英镑），而延迟治疗组为42,405英镑（95%置信区间：25,457英镑至59,354英镑）[p<0.04]。出院后12个月随访时观察到成本差异为 -20,218英镑（95%置信区间：-52,173英镑至11,783英镑）。