Magid D, Douglas J M, Schwartz J S
Robert Wood Johnson Clinical Scholars Program, University of Washington, Seattle, USA.
Ann Intern Med. 1996 Feb 15;124(4):389-99. doi: 10.7326/0003-4819-124-4-199602150-00002.
To compare the economic consequences of doxycycline therapy with those of azithromycin therapy for women with uncomplicated cervical chlamydial infections.
Decision analysis in which the health outcomes, costs, and cost-effectiveness of two provider-administered treatment strategies for women with uncomplicated cervical chlamydial infections were compared: 1) initial therapy with doxycycline, 100 mg orally twice daily for 7 days (estimated cost, $5.51) and 2) initial therapy with azithromycin, 1 g orally administered as a single dose (estimated cost, $18.75).
Under baseline assumptions, the azithromycin strategy incurred fewer major and minor complications and was less expensive overall than the doxycycline strategy despite a higher initial cost for acquiring antibiotic agents. In univariate sensitivity analyses, the azithromycin strategy prevented more major complications but was more expensive than the doxycycline strategy when doxycycline effectiveness was greater than 0.93. In a multivariate sensitivity analysis combining 11 parameter estimates selected so that the cost-effectiveness of the doxycycline strategy would be maximized relative to that of the azithromycin strategy, the azithromycin strategy resulted in fewer complications but was more costly. The incremental cost-effectiveness was $521 per additional major complication prevented. However, if the difference in the cost of azithromycin and doxycycline decreased to $9.80, the azithromycin strategy was less expensive and more effective, even under these extreme conditions.
On the basis of the best available data as derived from the literature and experts, the azithromycin strategy was more cost-effective than the doxycycline strategy for women with uncomplicated cervical chlamydial infections. Despite the dominance of the azithromycin strategy over the doxycycline strategy, the adoption of the azithromycin strategy may be limited by the practical financial constraints of our currently fragmented health care system, in which the costs and benefits of preventing chlamydia sequelae are often incurred by different components of the system.
比较强力霉素疗法与阿奇霉素疗法对患有单纯性宫颈衣原体感染女性的经济影响。
决策分析，比较两种由医疗服务提供者实施的针对患有单纯性宫颈衣原体感染女性的治疗策略的健康结果、成本及成本效益：1）强力霉素初始疗法，口服100毫克，每日两次，共7天（估计成本为5.51美元）；2）阿奇霉素初始疗法：口服1克，单次给药（估计成本为18.75美元）。
在基线假设下，阿奇霉素策略引发的严重和轻微并发症较少，尽管获取抗生素的初始成本较高，但总体成本低于强力霉素策略。在单因素敏感性分析中，当强力霉素有效性大于0.93时，阿奇霉素策略预防的严重并发症更多，但成本高于强力霉素策略。在多因素敏感性分析中，结合11个参数估计值，以使强力霉素策略相对于阿奇霉素策略的成本效益最大化，结果显示阿奇霉素策略引发的并发症较少，但成本更高。每预防一例额外的严重并发症，增量成本效益为521美元。然而，如果阿奇霉素和强力霉素的成本差异降至9.80美元，即使在这些极端条件下，阿奇霉素策略成本更低且更有效。
根据从文献和专家处获得的最佳现有数据，对于患有单纯性宫颈衣原体感染的女性，阿奇霉素策略比强力霉素策略更具成本效益。尽管阿奇霉素策略优于强力霉素策略，但在我们当前分散的医疗保健系统中，阿奇霉素策略的采用可能会受到实际财务限制，在该系统中，预防衣原体后遗症的成本和收益往往由系统的不同组成部分承担。
