亚胺培南治疗ICU血流感染给药方案结合蒙特卡洛模拟的药物经济学评价

Pharmacoeconomic evaluation of imipenem against blood infection in ICU based on Monte Carlo simulation

目的:探讨不同的亚胺培南给药方案应用于重症医学科(ICU)血流感染治疗的经济效果。方法:调查某院ICU 2014年7月1日—2017年6月30日应用过亚胺培南西司他丁的血流感染病例共52例,按照实际给药方案分为A组500mg q12h,B组500mg q8h,C组1 000mg q8h(此3种方案均为静脉滴注30min),以及D 500mg q8h,E 500mg q6h(此2种方案均为静脉滴注2h)共5组,分别进行蒙特卡洛模拟(MCS),计算各方案的累积反应分数(CFR),进行成本效果分析(CEA)。结果:5组方案的成本效果比(C/E)分别为61.70,66.42,103.88,61.99,64.87,以A方案为参照,余下4种方案的增量成本效果比(ΔC/ΔE)分别为307.72,1431.33,72.45,155.15。结论:C/E最小的A方案对铜绿假单胞菌和鲍曼不动杆菌的抗菌活性较差,并非ICU血流感染最理想的方案。D方案的药物经济学评价效果优于B方案,而更高给药剂量的C方案和更多给药次数的E方案也并未体现出更高收益。

OBJECTIVE To evaluate the economic effects of different dosing regimens of imipenem against blood infection in ICU.METHODS The patients using imipenem against blood infection from July 1 st,2014 to June 30 th,2017 were enrolled in the Intensive Care Unit（ICU）.Totally 52 patients were divided into 5 groups according to imipenem dosing regimens,i.e,group A（500 mg q12 h,i.v.by 30 min）,group B（500 mg q8 h,i.v.by 30 min）,group C（1 000 mg q8 h,i.v.by 30 min）,group D（500 mg q8 h,i.v.by 2 h）and group E（500 mg q6 h,i.v.by 2 h）.Those dosing regimens were evaluated with Monte Carlo stimulation（MCS）and calculated for cumulative fraction of responses（CFR）,then assessed with pharmacoeconomic cost-effectiveness analysis（CEA）.RESULTS The C/Evalues of the 5 groups were 61.70,66.42,103.88,61.99 and64.87.Taking the C/Evalue of 5 mg q12 hgroup as the reference,theΔC/ΔEof the other 4 regimens were 307.72,1431.33,72.45 and 155.15,respectively.CONCLUSION Regimens A with minimal C/Evalue is not the ideal regimen in ICU since it has no good antibacterial activity against Pseudomonas aeruginosa or Acinetobacter baumannii.Regimen D is more effective than regimen B in term of pharmacoeconomic perspective.Regimen C with a higher dose or regimen E with a longer drug delivery time is not superior to regimen D.