基于决策树模型的3种药物治疗艰难梭菌感染成本-效果分析

Cost-effectiveness analysis of three drugs for Clostridium difficile infection based on decision tree model

目的:运用药物经济学评价方法,对甲硝唑、万古霉素、非达霉素治疗艰难梭菌感染(CDI)进行成本-效果分析,为临床CDI治疗提供卫生经济学参考。方法:查阅文献资料获取3种治疗药物的治愈率和复发率,建立决策树模型,进行成本-效果分析、单因素敏感性分析和概率敏感性分析。结果:相比由甲硝唑升级为万古霉素的治疗方案(甲硝唑方案,97.82%,4513.55元),直接使用万古霉素的治疗方案(万古霉素方案,97.23%,5171.88元)为绝对劣势,直接使用非达霉素的治疗方案(非达霉素方案,98.06%,18664.53元)相比甲硝唑方案的增量成本效果比(ICER)为每增加1%治愈率,费用增加约58310元。敏感性分析与成本-效果分析结果基本一致。结论:甲硝唑方案比万古霉素方案更具成本-效果优势,非达霉素方案ICER过高,不推荐常规使用。

Objective:To analyze the cost-effect of metronidazole,vancomycin and fidaxomicin for Clostridium difficile infection(CDI)by pharmacoeconomic evaluation method,in order to provide health economics references for clinic.Methods:The cure rate and recurrence rate of the 3 drugs were obtained by retrieving literatrue and the decision tree model was established for cost-effectiveness analysis,single factor sensitivity analysis,and probabilistic sensitivity analysis for 3 drugs.Results:Compared with metronidazole regimen(upgrade from metronidazole to vancomycin,97.82%,4513.55 yuan),vancomycin regimen(using vancomycin directly,97.23%,5171.88 yuan)was absolute inferiority.The incremental cost effect ratio(ICER)of fidaxomicin regimen(using fidaxomicin directly,98.06%,18664.53 yuan)compared with metronidazole regimen was 58310 yuan per 1%cure rate.Results of sensitivity analysis was basically consistent with those of the cost-effectiveness analysis.Conclusion:Metronidazole regimen showed better cost-effectiveness than vancomycin regimen.The ICER of fidaxomicin regimen was too high to be routinely recommended.