降钙素原指导抗菌药物治疗下呼吸道感染的经济学评价

Economic Evaluation of PCT-guided Antibiotic Stewardship for Lower Respiratory Tract Infection

目的评估在中国医疗环境下检测降钙素原(PCT)水平指导抗菌药物治疗下呼吸道感染患者的经济性。方法本研究对国外已发表的模型进行中国本土化调整,构建决策树模型,模拟对比分别使用PCT指导治疗和常规治疗(不使用PCT)的次均住院总费用,以及国内某三甲医院治疗下呼吸道感染患者的年住院总费用。模型中的医疗资源使用参数来源于公开发表的文献,并辅以专家咨询进行校验。成本参数主要来源于北上广医疗服务价格均值。研究对上述参数进行了单因素敏感性分析。结果相比于常规治疗,PCT指导治疗下呼吸道感染可使每例患者次均住院总费用由8784.8元降到7944.2元,节省9.2%;可使一家三甲医院年住院总费用节省2584274元。单因素敏感性分析显示结果具有稳定性。结论使用PCT指导治疗下呼吸道感染可降低患者次均住院总费用,节约医疗服务成本,促进医疗资源的合理利用。

Objective To assess the economic implication of procalcitonin(PCT)guided antibiotic stewardship for hospitalized lower respiratory tract infection(LRTI)patients in China.Methods A decision tree was built on the local adaptation of the published US model to compare the total hospitalization cost per LRTI patient using PCT-guided therapy vs.standard care(without PCT),as well as the annual total cost of all LRTI patients in a typical tier 3 hospital.The parameters of healthcare resource use in the model are derived from published literature and validated by expert consultation.The cost parameters were mainly derived from the average price of medical services in Beijing,Shanghai Guangdong.One-way sensitivity analyses were performed for the parameters mentioned above.Results Compared to standard care,PCT-guided therapy reduces the total hospitalization cost per LRTI patient by 9.2%from CNY 8784.8 to CNY 7944.2.The annual hospitalization cost of all LRTI patients in a hospital can be saved CNY 2584274 by using PCT-guided therapy.One-way sensitivity analyses proved the results of the analysis are stable.Conclusion Using PCT-guided therapy in LRTI patients is associated with a shorter length of stay,a reduction in antibiotic treatment and exposure,and fewer AMR cases,leading to a substantially lower total hospitalization cost.