头孢他啶/阿维巴坦治疗耐碳青霉烯肺炎克雷伯菌致医院获得性肺炎的成本-效果分析

Cost-Effectiveness Analysis of Ceftazidime/Avibactam in the Treatment of Hospital-Acquired Pneumonia due to Carbapenem-Resistant Klebsiella pneumoniae

目的运用药物经济学评价方法,对头孢他啶/阿维巴坦、替加环素和多黏菌素B 3种治疗方案用于治疗碳青霉烯耐药的肺炎克雷伯菌引起的医院获得性肺炎进行成本-效果分析,为临床抗感染治疗决策提供参考。方法从医疗机构角度出发,建立决策树模型,成本参数来源于北京市药品阳光采购平台,概率参数来源于已发表的文献,并进行单因素敏感性和概率敏感性分析。结果通过成本-效果分析,与替加环素治疗方案相比,多黏菌素B治疗方案的增量成本效果比为-786128.42元/质量调整生命天,为绝对劣势方案;头孢他啶/阿维巴坦的增量成本效果比为11855.75元/质量调整生命天,按照调查问卷结果所假设的意愿支付阈值比不具有成本-效果。在概率敏感性分析中,当意愿支付阈值在30000元以上时,头孢他啶/阿维巴坦具有成本-效果概率是95.1%。结论对于碳青霉烯耐药的肺炎克雷伯菌引起的医院获得性肺炎,基于替加环素的治疗方案比头孢他啶/阿维巴坦和多黏菌素B更具有经济性,临床医生可根据患者的支付意愿酌情选择。

OBJECTIVE To evaluate the cost-effectiveness of the therapy of ceftazidime/avibactam-based,tigecycline-based,polymyxin B-based in the treatment of hospital-acquired pneumonia due to carbapenem-resistant Klebsiella pneumoniae,by using pharmacoeconomical method,so as to provide a reference for clinical decisions of anti-infective therapy.METHODS A decision tree model was developed from health-care system perspective,cost parameters were derived from the website of Beijing medicine sunshine purchasing,probabilistic parameters were derived from published literature.Furthermore,one-way and probabilistic sensitivity analyses were also conducted.RESULTS Through the incremental cost-effectiveness ratio analysis,compared with the treatment of tigecycline-based,the cost-effectiveness ratio of the treatment of polymyxin B-based was-786128.42 yuan/quality adjusted life day,which became an absolute disadvantage treatment;the cost-effectiveness ratio of ceftazidime/avibactam-based was 11855.75 yuan/quality adjusted life day,which was not cost-effective at a willingness-to-pay threshold of the result of the questionnaires.In the probabilistic sensitivity analysis,the probability of CAZ/AVI having cost-effectiveness was 95.1%when the willingness-to-pay threshold was above 30000 yuan.CONCLUSION Tigecycline-based treatment has economic advantage over ceftazidime/avibactam and polymyxin B,in treatment of hospital-acquired pneumonia due to carbapenem-resistant Klebsiella pneumoniae,clinicians may discretionary choose according the willingness-to-pay of different patients.