三种常用碳青霉烯类抗菌药物治疗呼吸系统和/或泌尿系统细菌感染的循证药物经济学评价

Evidence-based Pharmacoeconomic Evaluation on Three Kinds of Common Carbapenem Drugs in TreatingRespiratory and/or Urinary Bacterial Infection

目的采用药物经济学循证方法比较比阿培南、美罗培南和亚胺培南/西司他丁治疗呼吸系统和/或泌尿系统细菌感染的成本-效果。方法计算机检索中国知网(CNKI)、维普中文期刊全文数据库(VIP)、万方数据知识服务平台,并手动检索相关杂志、会议论文及学术论文,检索比阿培南、美罗培南、亚胺培南/西司他丁治疗呼吸系统和/或泌尿系统细菌感染的相关文献,检索时间2000—2017年。评价3种碳青霉烯类抗菌药物治疗14 d的临床疗效和细菌清除效果,计算成本-效果比(C/E)和增量成本-效果比(ΔC/ΔE),并观察不良反应发生情况。结果共纳入13篇文献,包括1 574例呼吸系统和/或泌尿系统细菌感染患者,10个生产厂家。根据治疗方案及药物生产厂家将所有患者分为A组326例、B组72例、C组59例、D组132例、E组415例、F组114例、G组213例、H组153例、I组40例、J组50例。H组患者临床疗效和细菌清除效果的C/E均为最小,以H组作为对照计算ΔC/ΔE,结果显示,C组、E组、F组、I组和J组患者临床疗效的ΔC/ΔE为负值;A组、B组、D组和G组患者临床疗效的ΔC/ΔE为正值,且4组患者临床疗效的ΔC/ΔE>C/E(H组)。B组、C组、E组、F组、G组、I组和J组患者细菌清除效果的ΔC/ΔE为负值;A组、D组患者细菌清除效果的ΔC/ΔE为正值,且两组患者细菌清除效果的ΔC/ΔE>C/E(H组)。本研究假设药品费用下降15%,其他费用不变,进行敏感性分析,结果与成本-效果分析一致。13篇文献均报道了药物相关不良反应,10组患者不良反应发生率比较,差异无统计学意义(P>0.05)。结论基于现有文献证据,美罗培南(浙江海正药业股份有限公司生产)0.5 g/次、1次/8~12 h是治疗呼吸系统和/或泌尿系统细菌感染的最优治疗方案。

Objective To compare the cost-effectiveness of biapenem,meropenem,imipenem/cilastatin in treating respiratory and/or urinary bacterial infection through evidence-based approach pharmacoeconomic evaluation.Methods CNKI,VIP and Wanfang Data Knowledge Service Platform were searched by computer,and related journals,conference papers and academic papers were manually searched to collect pertinent literatures about biapenem,meropenem,imipenem/cilastatin in treating respiratory and/or urinary bacterial infection from 2000 to 2017.Clinical effect and bacterial clearance effect of the three kinds of common carbapenem drugs were evaluated,cost-effectiveness ratio(C/E)and incremental cost-effectiveness ratio(ΔC/ΔE)were calculated,and incidence of adverse reactions was observed.Results A total of 13 literatures were involved,including 1 574 patients with respiratory and/or urinary bacterial infection and 10 drug manufacturers.According to therapeutic regimen and drug manufacturer,all of the 1 574 patients were divided into A group(n=326),B group(n=72),C group(n=59),D group(n=132),E group(n=415),F group(n=114),G group(n=213),H group(n=153),I group(n=40)and J group(n=50).C/E of clinical effect and bacterial clearance effect in H group were both the least,thus we take H group as control and found that,ΔC/ΔE of clinical effect in C group,E group,F group,I group and J group was negative,respectively,whileΔC/ΔE of clinical effect in A group,B group,D group and G group was positive and higher than C/E in H group,respectively;ΔC/ΔE of bacterial clearance effect in B group,C group,E group,F group,G group,I group and J group was negative,respectively,whileΔC/ΔE of bacterial clearance effect in A group and D group was positive and higher than C/E in H group,respectively.We assume that cost of medicine decreased by 15%and other costs stayed the same,the sensitivity analysis results were consistent with the costeffectiveness analysis results.All of the 13 literatures reported drugs related adverse reactions,but no statistically significant differences of incidence of adverse reactions was found in the ten groups(P>0.05).Conclusion Based on existing literature evidence,meropenem(produced by Zhejiang Haizheng Pharmaceutical Co.,LTD.,0.5 g per time,1 time per 8 to 12 hours)is the best therapeutic regimen in treating respiratory and/or urinary bacterial infection.