利奈唑胺与万古霉素治疗革兰阳性球菌感染的循证药物经济学分析

Evidence-based Pharmacoeconomic Analysis of Linezolid and Vancomycin in the Treatment of Gram-positive Coccal Infections

目的基于Meta分析评价利奈唑胺和万古霉素治疗革兰阳性球菌感染的安全性、有效性和经济性。方法计算机系统检索PubMed、Medline、Embase、Cochrane library和中国期刊全文数据库、万方数据知识服务平台等数据库,检索利奈唑胺和万古霉素治疗革兰阳性球菌感染的随机对照试验(RCT),利用RevMan5.3软件对利奈唑胺和万古霉素治疗革兰阳性球菌感染的临床疗效和安全性进行Meta分析,采用成本-效果分析进行经济学评价。结果共纳入8篇文献,总计5322例患者。Meta分析结果显示:在临床可评估患者中,当随访期结束后利奈唑胺组的临床治愈率优于万古霉素组,差异有统计学意义(OR=1.31,95%CI:1.08～1.58,Z=2.73,P=0.006)。亚组分析显示,在肺炎组(OR=1.32,95%CI:1.02～1.70,P=0.03)和皮肤软组织组(OR=1.48,95%CI:1.06～2.07,P=0.02),利奈唑胺的临床治愈率亦优于万古霉素,差异均有统计学意义(均P<0.05);菌血症组两组的临床治愈率相当(OR=1.05,95%CI:0.61～1.81,P=0.85)。利奈唑胺与万古霉素总体药物相关不良反应发生率比较差异无统计学意义(OR=1.00,95%CI:0.87～1.15,P=0.99),但万古霉素组肾功能异常发生率(3.39%)高于利奈唑胺组(1.64%),差异有统计学意义(OR=0.48,95%CI:0.29～0.78,P=0.004);利奈唑胺组血小板减少症发生率(2.66%)高于万古霉素组(1.41%),差异有统计学意义(OR=1.86,95%CI:1.20～2.88,P=0.006)。增量成本-效果比为1220.81,在意愿支付范围内,利奈唑胺相对于万古霉素具有较好的成本-效果比。结论针对由革兰阳性球菌感染导致的肺炎和皮肤软组织感染患者,在意愿支付范围内,利奈唑胺相对于万古霉素具有较好的经济性;对于革兰阳性球菌感染的菌血症和脓毒血症患者,对于肾功能无明显异常患者,万古霉素的经济性优于利奈唑胺。

Objective To evaluate the effectiveness, safety and economy about linezolid versus vancomycin for treatment of Gram-positive cocci infections based on Meta-analysis. Methods The data were collected from the PubMed, MEDLINE,EMBASE, Cochrane library, CNKI, Wanfang, etc through computer. Randomized controlled trials comparing linezolid with vancomycin in patients with Gram-positive cocci infections were eligible for inclusion. Meta-analysis was performed by using RevMan 5.3 software, while cost-effectiveness analysis was used for economic evaluation. Results A total of 8 RCTs were included involving 5322 patients. Meta-analysis results showed that with respect to clinical treatment success, linezolid was more effective than vancomycin in clinically evaluable patients after follow-up period(OR=1.31, 95% CI:1.08-1.58, Z=2.73, P=0.006).Linezolid also showed clinical efficacy superior to vancomycin in the subgroup of pneumonia(OR=1.32, 95% CI: 1.02-1.70,P=0.03) or skin and soft-tissue infections(OR=1.48, 95% CI: 1.06-2.07, P=0.02). There was no difference in clinical success for patients with bacteraemia(OR=1.05, 95% CI: 0.61-1.81, P=0.85). Although no difference was found regarding the overall incidence of drug-related adverse events(OR=1.00, 95% CI : 0.87-1.15, P=0.99), there were fewer incidents of abnormal renal function in the linezolid group compared with that in the vancomycin group(OR=0.48, 95% CI : 0.29-0.78, P=0.004). In addition, thrombocytopenia was recorded more commonly in the linezolid group compared with that in the vancomycin group, having statistical difference(OR=1.86, 95% CI: 1.20-2.88, P=0.006). The incremental cost-effectiveness ratio was 1220.81. Linezolid group for treatment of Gram-positive cocci infections has better cost-effectiveness than that in vancomycin group under willingness to pay. Conclusion For patients with pneumonia and skin and soft tissue infections caused by Gram-positive cocci infections, linezolid is more economical than vancomycin within the scope of willingness to pay;for patients with bacteremia and sepsis caused by Gram-positive cocci infections, vancomycin is more economical than linezolid in patients with no obvious abnormal renal function.