卡泊芬净治疗老年侵袭性真菌感染的循证药物经济学评价

Evidence-based pharmacoeconomic evaluation of caspofungin in the treatment of elderly patients with invasive fungal infection

目的系统评价卡泊芬净治疗老年侵袭性真菌感染(invasive fungal infection,IFI)的有效性、安全性与经济性,为临床治疗提供循证参考。方法计算机检索PubMed、Cochrane图书馆、Embase、CNKI、中国期刊全文数据库、VIP及万方数据库等,收集卡泊芬净治疗老年IFI的随机对照试验(randomized controlled trials,RCT),对符合纳入标准的文献进行资料提取,并采用改良Jadad量表评价纳入文献的质量,采用RevMan 5.3软件对临床总有效率和药品不良反应发生率进行meta分析,采用成本-效果分析方法进行经济学评价,并进行单因素敏感性分析和概率敏感性分析。结果共纳入6项RCT,合计551例患者。meta分析结果显示,试验组(卡泊芬净组)患者总有效率显著高于对照组(其他药物组),差异有统计学意义[OR=2.54,95%CI(1.75,3.69),P<0.001];两组患者药品不良反应发生率比较差异无统计学意义[OR=0.43,95%CI(0.16,1.17),P=0.10]。药物经济学评价结果显示,卡泊芬净的临床有效率最高,但是成本也较高。卡泊芬净的经济性始终优于两性霉素B脂质体,相对于伊曲康唑、伏立康唑与两性霉素B增加的成本也在可接受范围内。结论卡泊芬净治疗老年IFI的有效性、安全性与经济性均较好。但此结论有待更多大样本、高质量、多中心的RCT进一步验证。

Objective To systematically evaluate the effectiveness,safety and economy of capofungin in the treatment of elderly invasive fungal infection(IFI),and to provide evidence-based reference for clinical treatment.Methods Computer search of PubMed,Cochrane Library,Embase,CNKI,Chinese Journal Full-text Database,VIP and Wanfang Database,etc.,collect randomized controlled trials(RCT)of caspofungin in the treatment of elderly IFI,and extract data from literature that meets the inclusion criteria.The modified Jadad scale was used to evaluate the quality of the included literature,the RevMan 5.3 software was used to conduct meta-analysis of the total clinical effectiveness and the incidence of adverse drug reactions,the cost-effectiveness analysis method was used to conduct economic evaluation,and the single-factor sensitivity analysis and Probability sensitivity analysis.Results A total of 6 RCTs were included,with a total of 551 patients.The results of meta-analysis showed that the total effective rate of patients in the experimental group(caspofungin group)was significantly higher than that of the control group(other drug groups),and the difference was statistically significant[OR=2.54,95%CI(1.75,3.69),P<0.001];There was no significant difference in the incidence of adverse drug reactions between the two groups of patients[OR=0.43,95%CI(0.16,1.17),P=0.10].The pharmacoeconomic evaluation results showed that caspofungin had the highest clinical effectiveness,but the cost is also higher.Caspofungin was always more economical than amphotericin B liposomes,and the increased cost relative to itraconazole,voriconazole and amphotericin B was also within an acceptable range.Conclusion Caspofungin is effective,safe and economical in the treatment of elderly IFI.However,this conclusion needs to be further verified by more large-sample,high-quality,multi-center RCTs.