抗生素序贯治疗老年急性下呼吸道感染的成本-效果分析

Cost-Effectiveness Analysis about Sequential Antibiotic Therapy in Elderly Inpatients with Acute Lower Respiratory Tract Infection

采用前瞻性、随机对照临床干预研究设计和药物经济学中的最小成本分析法,对老年急性下呼吸道感染患者的两种治疗方案:静脉、口服序贯治疗组和连续静脉治疗组进行了临床疗效对比,同时对两组患者细菌清除率、静脉治疗时间、住院日等进行比较,对两组的抗菌药物医疗费用进行药物经济学评价。发现:两种疗法的临床疗效相同,患者细菌清除率、体温、血像、胸片恢复正常的时间相似,差异无显著性(P>0.05),但序贯组的静脉用药时间、平均住院日和抗菌药物费用明显低于对照组(P<0.05).从而得出结论:对老年急性下呼吸感染患者抗菌药物序贯治疗是安全而有效的,而且有更加合理的成本-效果比,由静脉治疗转换口服治疗的最佳时间约为7d.

By using a clinical prospective intervention study of random sample contrast and minimum cost analysis of pharmacoeconomics,a comparison has been made about the clinical curative effect of two kinds of therapy methods including intravenous oral sequential therapy group （sequential group） and continuous intravenous infusion therapy group （intravenous group）. Meanwhile,the differences of two groups in the bacterial clearance rate,treatment time of intravenous infusion and length of hospitalization day are also investigated. Furthermore,the costs of antibiotics for the two groups are evaluated as well from the perspective of pharmacoeconomics. Results obtained： the two therapies have shown equivalence in bacteriology and clinical outcomes,since the two therapies＇bacteria clearance,the time of resto- ring to normal temperature,blood routine examination and chest X ray were practically close to each other,and the difference was insignificant（P〉0.05）. However,the time of intravenous infusion therapy and the length of hospitalization day had notable difference,and the antibacterial cost of sequential group was obviously lower than that of intravenous group （P〈0. 05）. Therefore,the conclusion can be drawn that sequential therapy is safe and effective,and has more reasonable cost-effectiveness ratio in treating the elderly with acute lower respiratory tract infection. Moreover, the optimum switching time from intravenous infusion therapy to oral antibiotics therapy is about seven days.