Klassen T P, Rowe P C, Gafni A
Department of Pediatrics, University of Ottawa, Ontario, Canada.
J Pediatr. 1993 Apr;122(4):538-42. doi: 10.1016/s0022-3476(05)83532-2.
To determine the costs and clinical outcomes of three alternative treatments of the acute phase of Kawasaki syndrome: aspirin alone; low doses of intravenously administered immune globulin (IVIG-LD), 400 mg/kg per dose for 4 days; and high doses of intravenously administered immune globulin (IVIG-HD), 2.0 gm/kg for one dose.
A model was developed that assumed the inclusion of 100 patients with acute Kawasaki syndrome in each treatment option. Costs were valued by using the Chedoke-McMaster Corporate Cost Model in 1992 Canadian dollars. Clinical outcome, based on the published literature, was measured by the prevalence of coronary artery dilation at 7 weeks from the diagnosis of Kawasaki syndrome.
For every 100 patients with Kawasaki syndrome, the cost was reduced by $323,400 when aspirin therapy alone was changed to IVIG-HD therapy and 14 cases of coronary artery dilation were thereby prevented. When IVIG-HD therapy was compared with IVIG-LD therapy, the cost was reduced by $118,200 because two cases of coronary artery aneurysm were prevented. This latter result was sensitive to the duration of hospitalization, with IVIG-HD costing $8500 more for every 100 patients than IVIG-LD when it was assumed that both groups were hospitalized for 5 days, an unlikely occurrence.
Treatment with IVIG-HD for Kawasaki syndrome is preferred because it results in both lower costs and lower rates of coronary artery dilation.
确定川崎综合征急性期三种替代治疗方案的成本及临床结局：单独使用阿司匹林；低剂量静脉注射免疫球蛋白（IVIG-LD），每剂400mg/kg，共4天；高剂量静脉注射免疫球蛋白（IVIG-HD），一剂2.0g/kg。
建立一个模型，假设每种治疗方案纳入100例急性川崎综合征患者。成本以1992年加拿大元使用切多克-麦克马斯特公司成本模型进行估值。根据已发表的文献，临床结局通过川崎综合征诊断后7周时冠状动脉扩张的发生率来衡量。
对于每100例川崎综合征患者，当单独使用阿司匹林治疗改为IVIG-HD治疗时，成本降低323,400美元，从而预防了14例冠状动脉扩张。当将IVIG-HD治疗与IVIG-LD治疗进行比较时，成本降低118,200美元，因为预防了2例冠状动脉瘤。后一结果对住院时间敏感，假设两组均住院5天（这不大可能发生），每100例患者IVIG-HD比IVIG-LD多花费8500美元。
川崎综合征采用IVIG-HD治疗更佳，因为其成本更低且冠状动脉扩张发生率更低。
