Marchetti A, Magar R, Fischer J, Sloan E, Fischer P
Department of Pharmacy Practice, College of Pharmacy, University of Illinois at Chicago, USA.
Clin Ther. 1996 Sep-Oct;18(5):953-66. doi: 10.1016/s0149-2918(96)80051-8.
The cost of emergency department services has become a major concern for patients, providers, and payers. Solid economic information is needed to provide a rationale for the selection of therapeutic options and the provision of care that is both clinically and financially prudent. To assess the full cost of care for patients with seizures who are treated in an acute care setting, a modified activity-based cost-accounting model was developed. The model was populated with data from a double-masked, parallel-group, single-dose, multicenter clinical trial designed to investigate the safety and tolerability of phenytoin (Dilantin) and fosphenytoin (Cerebyx) given intravenously in equivalent loading doses according to established recommendations. A total of 52 patients were enrolled in the trial; 13 were given phenytoin and 39 were given fosphenytoin. Salaries and benefits of emergency medical services personnel, drug acquisition costs, and direct and indirect overhead expenditures common to a large hospital emergency department comprised the total costs to treat enrolled patients and manage adverse events. The average cost to treat patients with fosphenytoin was lower than the cost to treat similar patients with phenytoin based on the frequency of adverse events associated with each comparator and the resources (human and material) consumed in the management of those events.
急诊科服务的成本已成为患者、医疗服务提供者和支付方主要关注的问题。需要可靠的经济信息，以便为选择治疗方案以及提供临床和财务上都审慎的护理提供依据。为了评估在急性护理环境中接受治疗的癫痫患者的全部护理成本，开发了一种改良的基于活动的成本核算模型。该模型的数据来自一项双盲、平行组、单剂量、多中心临床试验，该试验旨在根据既定建议，研究静脉注射等效负荷剂量的苯妥英钠（大仑丁）和磷苯妥英钠（开浦兰）的安全性和耐受性。共有52名患者参加了该试验；13名患者接受了苯妥英钠治疗，39名患者接受了磷苯妥英钠治疗。大型医院急诊科急救医疗服务人员的薪资和福利、药品采购成本以及直接和间接间接费用支出构成了治疗登记患者和处理不良事件的总成本。基于与每个对照药物相关的不良事件发生频率以及处理这些事件所消耗的资源（人力和物力），使用磷苯妥英钠治疗患者的平均成本低于使用苯妥英钠治疗类似患者的成本。
