Partsch D J, Paladino J A
State University of New York at Buffalo, USA.
Ann Pharmacother. 1997 Oct;31(10):1137-45. doi: 10.1177/106002809703101004.
To compare the cost-effectiveness of sequential intravenous-to-oral ofloxacin versus intravenous-to-oral standard switch therapy for the treatment of patients with sepsis who are hospitalized with bacterial infections.
Cost-effectiveness analysis from a provider perspective, including resources important to an integrated healthcare network, of a randomized, open-label, controlled, clinical trial.
Millard Fillmore Health System, Buffalo, NY.
Hospitalized adults requiring parenteral antibiotics for a complicated urinary tract infection, lower respiratory tract infection, or skin and soft tissue infection.
Sequential intravenous-to-oral ofloxacin or standard intravenous-to-oral switch antibiotics.
Clinical outcomes and direct costs associated with hospitalization, primary physician services, specialist physician services, and outpatient care.
Eighty-two of 89 patients randomized into the two treatment groups were evaluable. Standard switch therapy failed with 12 patients versus 10 patients receiving ofloxacin. Complete economic data were available for 74 patients. Sequential ofloxacin therapy resulted in a 1-day-shorter antibiotic-related hospitalization without evidence of recurrent infection during the posttherapy follow-up evaluations. An average cost savings of $399 per patient was achieved in the sequential ofloxacin group. Although this difference did not attain statistical significance (probably due to the large variance), it is an economically significant finding. The cost-effectiveness ratios were $5735 per successful outcome for the standard switch therapy group versus $5126 per successful outcome in the sequential ofloxacin group.
Sequential ofloxacin was as effective and consistently less expensive than standard switch antibiotics in the initial evaluation and in the sensitivity analysis of room cost and drug acquisition cost. Standard switch therapy would have to be greater than 25% more effective than sequential ofloxacin therapy to change the economic decision.
比较左氧氟沙星序贯静脉-口服疗法与标准静脉-口服转换疗法治疗因细菌感染住院的脓毒症患者的成本效益。
从医疗机构角度进行成本效益分析，纳入对综合医疗网络重要的资源，基于一项随机、开放标签、对照临床试验。
纽约州布法罗市的米勒德·菲尔莫尔健康系统。
因复杂性尿路感染、下呼吸道感染或皮肤及软组织感染需接受肠外抗生素治疗的住院成人。
左氧氟沙星序贯静脉-口服疗法或标准静脉-口服转换抗生素疗法。
与住院、初级医师服务、专科医师服务及门诊护理相关的临床结局和直接成本。
随机分为两个治疗组的89例患者中有82例可进行评估。标准转换疗法有12例治疗失败，而接受左氧氟沙星治疗的有10例。74例患者有完整的经济数据。左氧氟沙星序贯疗法使抗生素相关住院时间缩短1天，且在治疗后随访评估期间无复发感染迹象。左氧氟沙星序贯治疗组平均每位患者节省成本399美元。尽管这一差异未达到统计学显著性（可能由于方差较大），但在经济方面具有显著意义。标准转换疗法组每成功治疗一例的成本效益比为5735美元，而左氧氟沙星序贯治疗组为5126美元。
在初始评估以及病房成本和药品采购成本的敏感性分析中，左氧氟沙星序贯疗法与标准转换抗生素疗法效果相当，但成本持续较低。标准转换疗法必须比左氧氟沙星序贯疗法有效率高25%以上才能改变经济决策。
