急性阑尾炎单病种临床路径抗菌药物成本一效果分析

Cost-effectiveness analysis of antimicrobial programs for acute appendicitis in single disease clinical pathway

目的对急性阑尾炎单病种临床路径不同方案抗菌药物进行成本一效果分析，以确定优选方案。方法抽取2012年1月至2013年12月南京市高淳人民医院进入临床路径、应用排名前4位抗菌药物方案的急性阑尾炎病例260例，根据抗菌药物方案将病例分为头孢两丁钠组（65例）、盐酸头孢替安＋甲硝唑组（64例）、盐酸头孢替安组（66例）和盐酸头孢替安＋奥硝唑组（65例）。比较4组住院费用（C1）和抗菌药物成本（C2），计算并比较成本-效果比（C／E）及增量成本-效果比（AC／AE）。结果4组治疗有效率差异无统计学意义（P〉0．05），其中头孢西丁钠组有效率最低。头孢西丁钠组、盐酸头孢替安＋甲硝唑组、盐酸头孢替安组和盐酸头孢替安＋奥硝唑组C1分别为（4876±50）、（4963±50）、（5126±52）、（5370±51）元，其中盐酸头孢替安＋奥硝唑组高于其他3组，盐酸头孢替安组高于头孢西丁钠组和盐酸头孢替安＋甲硝唑组，差异有统计学意义（P〈0．05）；C2分别为（725±76）、（865±86）、（885±90）、（1317±130）元，其中盐酸头孢替安＋奥硝唑组高于其他3组，盐酸头孢替安＋甲硝唑组和盐酸头孢替安组高于头孢西丁钠组，差异有统计学意义（P〈0．05）。头孢西丁钠组C1／E和C2／E均最低（50．3、7．5）；以有效率最低的头孢两丁钠组为对照，△C1／△E和△C2／△E由低至高均为盐酸头孢替安＋甲硝唑组、盐酸头孢替安组、盐酸头孢替安＋奥硝唑组（5775、16012、16049，9283、10292、19266）。结论从药物经济学角度考虑，急性阑尾炎单病种临床路径使用头孢西丁钠或盐酸头孢替安联合甲硝唑是较合理的方案。

Objective To analyze the cost-effectiveness of antimicrobial agents for acute appendicitis in single disease clinical pathway. Methods Totally 260 cases of acute appendicitis in clinical pathway who received top four antimierobial programs were collected and divided into cefoxitin group （65 cases ） , cefotiam ± metron- idazole group （64 cases）, cefotiam group （66 cases） , cefotiam ± ornidazole group （65 cases）. The effective rate was compared among groups; the hospitalization expenses （C1） and the cost of antibiotics （C2 ） were compared, the cost-effectiveness ratio （C/E）and incremental cost-effectiveness ratio （AC/AE） were calculated. Results The effective rate was not significantly different among groups （ P 〉 0. 05 ） , which was the lowest in cefoxitin group. The Ct was （4 876 ±50） , （4 963±50） , （5 126 ±52） and （5 370 ±51 ） yuan in cefoxitin group, eefotiam ± metronidazole group, cefotiam group and eefntiam ± ornidazole group; it was significantly higher in cefotiam ± ornidazole group than that in the other groups, and was significantly higher in cefotiam group than that in cefoxitin group and cefotiam ± metronidazole group （P 〈 0. 05 ）. The C2 was （725 ± 76） , （ 865 ± 86）, （885 ± 90） and （1 317 ± 130） yuan in cefoxitin group, eefotiam ＋ metronidazole group, cefotiam group and cefotiam ＋ omidazole group ; it was significantly higher in cefotiam ＋ ornidazole group than that in the other groups, and was significantly higher in cefotiam ± metronidazole group, eefotiam group than that in cefoxitin group （ P 〈 0. 05 ）. In cefoxitin group, both C1/E and C2/E were the lowest among 4 groups （50. 3 and 7.5 ）. Taken cefoxitin group as control, the ranks of ＋C1/△E and △C2/△E from low to high were both eefotiam ＋ metronidazole group, cefotiam group and cefotiam ＋ ornidazole group （5 775, 16 012, 16 049; 9 283, 10 292, 19 266）. Conclusion From a pharmacoeconomic point of view, cefoxitin or cefotiam combined with metronidazole is preferable in treating acute appendicitis in single disease clinical pathway.