急性阑尾炎手术患者应用抗菌药物的经济学评价

Pharmacoeconomic Evaluation of Individual Antimicrobial Therapeutic Schemes in Appendectomy Patients

目的分析急性阑尾炎手术患者的抗感染治疗方案,评价不同方案抗菌药物费用的经济性。方法收集2003-2005年急性阑尾炎手术患者病历286份,对其抗菌药物使用进行汇总分析,利用最小成本分析方法评价典型用药方案的经济性。结果患者共使用了24种不同的抗菌药物治疗方案,以硝咪唑类+β-内酰胺类和硝咪唑类+β-内酰胺类+氨基糖苷类(或克林霉素)最为典型;二联和三联用药的抗菌药物成本分别为1 671.46元和1 977.13元,选择甲硝唑、头孢他啶可以在不影响治疗效果的前提下,有效降低抗菌药物费用,三联用药中选择克林霉素比氨基糖苷类更为经济。结论急性阑尾炎手术患者抗菌药物使用基本合理,从经济学角度考虑,推荐使用甲硝唑+头孢他啶的用药方案,必要时可加用克林霉素。

OBJECTIVE To analyze the antimicrobial therapeutic schemes in appendectomy inpatients so as to evaluate the economic impact factors of each project. METHODS Totally 286 medical cases of appendectomy inpatients were chosen and analyzed from 2003 to 2005. The antimicrobial agent costs of each scheme were evaluated by using cost minimization analysis of pharmacoeconomic method. RESULTS There were 24 kinds of antimicrobial therapeutic schemes used by 286 cases. The commonest schemes were nitrodazoles ＋ β-lactams and nitrodazoles ＋β-lactams ＋ aminoglycosides（or clindamycin）. The drug costs were 1671.46 and 1977.13 yuan （RMB） individually in combination of two or three kinds of antimicrobial agents. Choosing metronidazole instead of ornidazole could reduce drug fee significantly, which was also observed in choosing ceftazidime instead of other β-lactams. CONCLUSIONS The antimicrobial drug utilization in our hospital is rational as a whole. Considering of economic factors, using metronidazole and ceftazidime （administering clindamycin if necessary） may be better than other schemes for prventing wound infection.