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头孢哌酮舒巴坦联合莫西沙星和阿米卡星对比联合替加环素治疗多重耐药鲍曼不动杆菌肺炎的药物经济学评价
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| 篇名： | 头孢哌酮舒巴坦联合莫西沙星和阿米卡星对比联合替加环素治疗多重耐药鲍曼不动杆菌肺炎的药物经济学评价 |
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| 摘要： | 目的：研究头孢哌酮舒巴坦联合莫西沙星和阿米卡星对比联合替加环素治疗多重耐药鲍曼不动杆菌（MDRAB）肺炎的有效性和经济性。方法：采用前瞻性研究方法，选取2016年1月1日－2019年8月31日荆门市第二人民医院收治的150例MDRAB肺炎患者，按随机数字表法分为对照组和观察组，每组75例。对照组患者予以注射用头孢哌酮钠舒巴坦钠（3 g，每8 h静脉滴注1次）联合注射用替加环素（首剂量100 mg，维持剂量50 mg，每12 h静脉滴注1次），观察组患者予以注射用头孢哌酮钠舒巴坦钠（3 g，每8 h静脉滴注1次）联合盐酸莫西沙星氯化钠注射液（400 mg，每日静脉滴注1次）和硫酸阿米卡星注射液（0.6 g，每日静脉滴注1次），均连续给药14 d。比较两组患者体温恢复正常时间、肺部啰音消失时间、白细胞计数恢复正常时间和降钙素原恢复正常时间，以及临床疗效、细菌清除率、不良反应发生情况。以抗菌药物费用为成本，采用成本-效果分析方法评价两组患者用药方案的成本-效果比（C/E）和增量成本-效果比（ΔC/ΔE），并通过下调15％的药品费用进行敏感性分析。结果：对照组和观察组患者的体温恢复正常时间、肺部啰音消失时间、白细胞计数恢复正常时间和降钙素原恢复正常时间比较，差异均无统计学意义（P＞0.05），临床有效率分别为85.33％、81.33％，细菌清除率分别为89.33 ％、82.67 ％，差异均无统计学意义（P＞0.05）。两组患者均未出现严重不良反应。对照组和观察组的抗菌药物费用分别为32 371.49、9 367.82元/人，临床有效率的C/E分别为379.37、115.18，细菌清除率的C/E分别为362.38、113.32，对照组相对于观察组临床有效率和细菌清除率的ΔC/ΔE分别为5 750.92和 3 454.00。敏感性分析支持成本-效果分析结果。结论：头孢哌酮舒巴坦联合莫西沙星和阿米卡星与头孢哌酮舒巴坦联合替加环素治疗MDRAB肺炎的临床疗效相当，其中头孢哌酮舒巴坦联用莫西沙星和阿米卡星更具经济学优势。 |
| ABSTRACT： | OBJECTIVE： To study the efficacy and economics of cefoperazone/sulbactam combined with moxifloxacin and amikacin versus cefoperazone/sulbactam combined with tigecycline in the treatment of pneumonia with multidrug-resistant Acinetobacter baumannii （MDRAB）. METHODS： By prospective study， 150 MDRAB pneumonia patients were selected from Jingmen Second People’s Hospital during Jan. 1st， 2016-Aug. 31st， 2019， and then randomly divided into control group and observation group， with 75 cases in each group. Control group was given Cefoperazone/sulbactam sodium for injection （3 g， q8 h， ivgtt） combined with Tigecycline for injection （first dose 100 mg， maintenance dose 50 mg， q12 h， ivgtt）. Observation group was give Cefoperazone/sulbactam sodium for injection （3 g， q8 h， ivgtt） combined with Moxifloxacin hydrochloride and sodium chloride injection （400 mg， qd， ivgtt） and Amikacin sulfate injection （0.6 g， qd， ivgtt）. The treatment lasted for 14 days in both groups. The time for body temperature to return to normal， lung rales disappearance， WBC to return to normal and PCT to return to normal， clinical efficacy， bacterial clearance rate and the occurrence of ADR were compared between 2 groups. Cost-effectiveness analysis was used to evaluate the cost- effectiveness ratio （C/E） and incremental cost-effectiveness ratio （ΔC/ΔE） of 2 groups using antibiotics cost as cost. Sensitivity analysis was performed by reducing drug cost by 15％. RESULTS： There was no statistical significance in the time for body temperature to return to normal， lung rales disappearance， WBC to return to normal and PCT to return to normal between control group and observation group （P＞0.05）. Clinical response rates of 2 groups were 85.33％ and 81.33％， and bacterial clearance rate were 89.33％ and 82.67％， with statistical significance （P＞0.05）. No serious ADR occurred in either group. The antibacterial cost of control group and observation group were 32 371.49 yuan/person and 9 367.82 yuan/person. C/E of clinical response rate were 379.37 and 115.18， and C/E of bacterial clearance rate were 362.38 and 113.32 in 2 groups， respectively. ΔC/ΔE of clinical response rate and bacterial clearance rate between control group and observation group were 5 750.92 and 3 454.00. Sensitivity analysis supported cost-effectiveness analysis results. CONCLUSIONS： Cefoperazone/sulbactam combined with moxifloxacin and amikacin versus cefoperazone/sulbactam combined with tigecycline in the treatment of pneumonia with MDRAB has similar efficacy， but cefoperazone/sulbactam combined with moxifloxacin and amikacin has economic and social benefits. |
| 期刊： | 2019年第30卷第23期 |
| 作者： | 李惊雷，阮祥梅，刘静，姜经航，杨明炜，刘琳，马松林，杨家敏 |
| AUTHORS： | LI Jinglei，RUAN Xiangmei，LIU Jing，JIANG Jinghang，YANG Mingwei，LIU Lin，MA Songlin，YANG Jiamin |
| 关键字： | 多重耐药鲍曼不动杆菌；肺炎；头孢哌酮舒巴坦；替加环素；莫西沙星；阿米卡星；成本-效果分析；临床疗效；药物经济学 |
| KEYWORDS： | Multidrug-resistant Acinetobacter baumannii； Pneumonia； Cefoperazone/sulbactam； Tigecycline； Moxifloxacin； Amikacin； Cost-effectiveness analysis； Clinical efficacy； Pharmacoeconomics |
| 阅读数： | 1327 次 |
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