3种青霉素类抗生素治疗儿科支气管肺炎的成本-效果分析

Cost Effectiveness Analysis of 3 Kinds of Penicillins Antibiotics in Treatment of Pediatric Bronchial Pneumonia

目的：研究不同药物治疗方案对儿科常见病支气管肺炎产生的成本-效果比,寻找最合理的临床路径。方法：在我院2014年儿科住院病例中选取支气管肺炎患者共281例,随机分成3组,分别给予注射用青霉素钠、注射用阿莫西林钠-克拉维酸钾、注射用哌拉西林钠-他唑巴坦钠3种药物进行抗菌治疗,运用药物经济学原理对治疗方案进行评价。结果：注射用青霉素钠成本-效果比率为4 846.63～4 877.30元/例;注射用阿莫西林钠-克拉维酸钾的成本-效果比率为1 985.79元/例;注射用哌拉西林钠-他唑巴坦钠的成本-效果比率为2 548.10元/例。增量分析得到注射用阿莫西林钠-克拉维酸钾相对于注射用青霉素钠为绝对优势方案;注射用哌拉西林钠-他唑巴坦钠相对于注射用青霉素钠增量成本-效果比为319.18～345.53元;注射用哌拉西林钠-他唑巴坦钠相对于注射用阿莫西林钠-克拉维酸钾增量成本-效果比为9 905.63元。结论：通过研究得到注射用阿莫西林钠-克拉维酸钾是对儿科支气管肺炎进行抗菌治疗的优选方案,花费较低的治疗成本可得到较好的治疗效果,为最合理的临床路径。

Objective： To study the cost-effectiveness ratio of the treatment of bronchial pneumonia as a common disease in pediatrics with different therapeutic regimens and to find out the most reasonable clinical pathway. Methods： About 281 patients with bronchial pneumonia were chosen from hospitalized patients of pediatrics in our hospital in 2014. They were randomly divided into 3 groups, each group was given penicillin sodium for injection, amoxilinna and clavulanate potassium for injection and piperacillin sodium and tazobactam sodium for injection respectively for antimicrobial therapy and the assessment was made on therapeutic schemes according to the principle of pharmacoeconomics. Results： The cost-effectiveness ratio of penicillin sodium for injection, amoxicillin sodium and clavulanate potassium for injection and piperacillin sodium and tazobactam sodium for injection was 4 846.63 ～4 877.30, 1 985.79 and 2 548.10 yuan/each respectively. The incremental analysis showed that the therapeutic scheme with amoxicillin sodium and clavulanate potassium for injection had an obvious advantage as opposed to piperacillin sodium for injection, the incremental cost-effectiveness ratio of piperacillin sodium and tazobactam sodium for injection was 319.18 ～ 345.53 as opposed to penicillin sodium for injection and 9 905.63 as opposed to amoxilinna and clavulanate potassium for injection. Conclusion： The results showed the using amoxilinna and clavulanate potassium for injection is an optimal therapeutic scheme for antimicrobial treatment of pediatric bronchial pneumonia, with lower treatment cost and better effectiveness. It can be regarded as the most reasonable clinical pathway.