万古霉素与利奈唑胺在中国治疗耐甲氧西林金黄色葡萄球菌感染的医院获得性肺炎的成本-效果分析

Cost-effectiveness analysis of vancomycin and linezolid in methicillin-resistant Staphylococcus hospital acquired pneumonia in China

目的:评估万古霉素与利奈唑胺在确诊为耐甲氧西林金黄色葡萄球菌(MRSA)引起的医院获得性肺炎(HAP)中的成本效果。方法:建立决策树模型,其中包含来源于既往研究和专家意见的有关临床参数如疗效、死亡率、严重不良事件发生率、治疗持续时间和住院时间。以成本效果比(CER)对两种治疗方案进行评估,并对结果进行单变量和概率灵敏度分析。结果:该模型得出万古霉素的成本为12 447.90元,利奈唑胺的成本为14 162.09元。万古霉素相对于利奈唑胺的增量成本为-1 714.19元,增量疗效为-2.69%。利奈唑胺相对于万古霉素的增量成本效果比(ICER)为63 488.51元。结论:首选万古霉素治疗MRSA引起的HAP成本效果优于首选利奈唑胺,但ICER在人均GDP的1~3倍之间,增加成本可以接受,首选利奈唑胺作为备选方案。

OBJECTIVE To evaluate the cost-effectiveness of vancomycin and linezolid in the diagnosis of nosocomial pneumonia(HAP) caused by methicillin-resistant Staphylococcus aureus(MRSA).METHODS A decision tree model was developed that included relevant clinical parameters derived from previous studies and expert opinion such as efficacy, mortality, incidence of serious adverse events, duration of treatment, and length of hospital stay. The two treatment options were assessed as cost-effectiveness ratios(CERs), and the results were subjected to univariate and probabilistic sensitivity analyses.RESULTS The model yielded a cost of 12 447.90 RMB for vancomycin and 14 162.09 RMB for linezolid. The incremental cost of vancomycin relative to linezolid was-1 714.19 RMB and the incremental efficacy was-2.69%. The incremental cost-effectiveness ratio(ICER) of linezolid versus vancomycin was 63 488.51 RMB.CONCLUSION Vancomycin appears to be more cost-effective compared to linezolid for MRSA HAP, but the ICER is between 1 and 3 times GDP per capita with acceptable incremental costs. Linezolid can be used as an alternative option.