达托霉素治疗复杂皮肤软组织感染的药物经济学评价

Pharmacoeconomics Evaluation of Daptomycin in the Treatment of Complex Skin and Soft Tissue Infections

目的评价达托霉素治疗复杂性皮肤软组织感染(cSSTIs)的临床效果、安全性及经济性。方法计算机检索中文和英文数据库,收集相关随机对照试验(RCT),进行临床治愈率和不良反应的meta分析及药物经济学分析。结果共纳入6篇RCT,共计820例患者。Meta分析结果显示,达托霉素与万古霉素的临床治愈率差异无统计学意义[RR=1.01,95%CI(0.94,1.08),P=0.88],达托霉素与替考拉宁的临床治愈率差异也无统计学意义[RR=1.02,95%CI(0.90,1.15),P=0.77]。达托霉素与万古霉素、替考拉宁的不良反应发生率相似。最小成本法分析结果显示,达托霉素治疗组的成本为9 218.25元,万古霉素治疗组的成本为4 138.60元,替考拉宁组为4 429.34元,敏感性分析表明结果稳定。结论与万古霉素和替考拉宁相比,达托霉素治疗cSSTIs并不具有经济性。但随着医疗保险政策的变化,达托霉素的经济学特征可能会改变,还有待进一步研究。

OBJECTIVE To evaluate the effectiveness, safety and economics of daptomycin in the treatment of complex skin and soft tissue infections(cSSTIs). METHODS Chinese and English literature database were searched, and relevant randomized controlled trials(RCTs) were included, meta-analysis and economics analysis based on the clinical cure rate and adverse reactions were conducted. RESULTS Six RCTs were included, involving 820 patients. The results of meta-analysis showed that, there was no significant difference in the clinical cure rate between the daptomycin group and the vancomycin group[RR=1.01, 95% CI(0.94, 1.08), P=0.88], and also in the daptomycin group and teicoplanin group [RR=1.02, 95%CI(0.90, 1.15), P=0.77]. The incidence of adverse reactions was similar in the daptomycin group compared with vancomycin and teicoplanin group. The results of cost-minimization analysis showed that the cost of the daptomycin group was 9 128.25 yuan, the cost of the vancomycin group was 4 138.60 yuan, and the teicoplanin group was 4 429.34 yuan. Meanwhile, the sensitivity analysis showed that the results were stable. CONCLUSION For patients with cSSTIs, daptomycin is not economical compared to vancomycin and teicoplanin. However, with the changes in medical insurance policies, the economic characteristics of daptomycin may be also changed and further researches are needed.