阿奇霉素预防计划性阴道分娩感染的成本-效用分析

Cost-effectiveness Analysis of Azithromycin Prophylaxis for Planned Vaginal Delivery Infection

目的从全社会角度出发,评价阿奇霉素对比安慰剂预防计划性阴道分娩感染的经济性。方法根据A-PLUS研究结果,使用TreeAge Pro 2022建立决策树模型,在全生命周期下,对两种预防方案进行成本-效用分析,年贴现率为5%,采用单因素和概率敏感性分析评估模型的稳健性。结果相对于安慰剂组患者(52.26418 QALYs和3996.17元),阿奇霉素组患者(52.26429 QALYs和3898.51元)的QALY提高0.00012 QALYs,成本降低97.66元,阿奇霉素预防方案为绝对优势方案。敏感性分析结果显示结果稳健。结论在预防计划性阴道分娩感染中,阿奇霉素比安慰剂更具有经济性,值得国内尝试开展更多本土的临床研究,并根据临床证据的更新及时对模型参数进行更新,以确保经济学评价的科学性。

OBJECTIVE To evaluate the cost-effectiveness of azithromycin compared with placebo for the prevention of planned vaginal delivery infection from the perspective of the whole society.METHODS Based on the results of the A-PLUS study,a decision tree model was established using TreeAge Pro 2022 to evaluate the cost-effectiveness of the two prevention schemes under the full life cycle.The annual discount rate was 5%,and univariate and probabilistic sensitivity analysis were used to assess the robustness of the model.RESULTS Compared to the placebo group of patients(52.26418 QALYs and 3996.17 yuan),patients in the azithromycin group(52.26429 QALYs and 3898.51 yuan)yielded an additional 0.00012 QALYs with an reduced cost of 97.66 yuan.Azithromycin prophylaxis regimen was an absolute superiority regimen.The results of the sensitivity analysis showed that the results were robust.CONCLUSION Azithromycin is more economical than placebo to prevent planned vaginal delivery infection,but more relevant clinical studies and pharmacoeconomic evaluation are needed in China.