3种方案治疗A族β溶血性链球菌致急性上呼吸道感染的最小成本分析

Cost-minimization Analysis of 3 Therapeutic Plans for Acute Upper Respiratory Tract Infection Caused by Group A β-hemolytic Streptococcus

目的:对治疗A族β溶血性链球菌(GAS)致急性上呼吸道感染的3种方案的经济性进行评价。方法:采用回顾性研究方法,选择我院2014年3月-2016年3月临床表现为急性上呼吸道感染且用咽拭子试验分离出GAS呈阳性的患者71例,按用药方法不同分为A组(16例)、B组(30例)和C组(25例)。A、B、C组患者分别采用一次性肌内注射苄星青霉素(120万U)、口服青霉素V钾(约0.5 g,q8 h,疗程10 d)、口服阿莫西林舒巴坦匹酯(1.0 g,bid,疗程10 d)3种治疗方案,观察临床疗效及细菌清除情况,并对3种方案进行经济学评价。结果:3组患者的治愈率分别为87.50%、90.00%、92.00%,细菌清除率分别为88.24%、87.88%、92.59%,差异均无统计学意义(P>0.05),故采用最小成本分析法进行药物经济学评价。3种方案的成本分别为237.79、279.49、400.40元,其中C方案的治愈率和细菌清除率最高,但成本也最高。敏感度分析结果与最小成本分析结果一致。结论:对于明确病原性细菌为GAS所致的反复发作的上呼吸道感染且有诱发风湿热风险的患者,肌内注射苄星青霉素可作为首选治疗方案;对于不愿接受注射用青霉素治疗且能保证用药时间的患者,可选择口服青霉素V钾;对于普通青霉素治疗效果不佳的患者,可选择口服阿莫西林舒巴坦匹酯。

OBJECTIVE:To evaluate the economical efficiency of3therapeutic plans for acute upper respiratory tract infectioncaused by group Aβ-hemolytic streptococcal(GAS).METHODS:In retrospective study,71GAS positive patients withacute upper respiratory tract infection in our hospital during Mar.2014-Mar.2016were selected and divided into group A(16cases),B(30cases),C(25cases)according to medication method.Group A,B,C were given intramuscular injection of benzathinebenzylpenicillin(1200000U),oral administration of penicillin V potassium(0.5g,q8h,10d)or oral administrationof amoxicillin sulbactam(0.5g,bid,10d),respectively.Clinical efficacy and bacterial clearance were observed,and economicsof3therapeutic plans were evaluated.RESULTS:The cure rates of3groups were87.50%,90.00%,and92.00%;bacterialclearance rates were88.24%,87.87%,and92.59%,respectively;there was no statistical significance(P>0.05).Cost-minimizationanalysis was adopted for pharmacoeconomic evaluation.The costs of3groups were237.79,279.49,400.40yuan,respectively.The cure rate and bacterial clearance rate of therapeutic plan C were the highest,but its cost also was the highest.The resultsof sensitivity analysis were consistent with the results of cost-minimization analysis.CONCLUSIONS:The intramuscular injectionof benzathine benzylpenicillin can be served as first choice therapeutic plan for recurrent upper respiratory tract infectioncaused by GAS and patients with rhenmatic fever risk.The patients who are reluctant to be treated with penicillin but guaranteemedication time can take penicillin V potassium orally.The patients with poor efficacy of common penicillin can take amoxicillinsulbactam pivoxil.