运用决策树模型对国产和进口万古霉素治疗耐甲氧西林金黄色葡萄球菌颅内感染进行成本-效果分析
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摘要
目的:分析国产注射用盐酸万古霉素(商品名:来可信)和进口注射用盐酸万古霉素(商品名:稳可信)治疗耐甲氧西林金黄色葡萄球菌(MRSA)颅内感染的有效性和经济性,为临床药物选择提供决策依据。方法:采用回顾性研究方法,收集2016年1月-2017年6月我院神经外科MRSA颅内感染并使用来可信或稳可信治疗的患者病例资料,其中来可信115例,稳可信42例,以有效率(包括临床治愈和临床好转)为效果指标,运用决策树模型对来可信和稳可信治疗MRSA颅内感染进行成本-效果分析,分别以成本下降10%和有效率下降10%进行敏感性分析。结果:来可信的有效率为85.21%,期望成本为13 125.96元,成本-效果比(CER)为15 404.25;稳可信的有效率为78.57%,期望成本为15 619.17元,CER为19 879.31,来可信与稳可信治疗MRSA颅内感染的有效率比较差异无统计学意义(P<0.05)。敏感性分析结果与成本-效果分析结果无差异。结论:来可信和稳可信治疗MRSA颅内感染的有效性相当,但来可信的CER低于稳可信的CER。
OBJECTIVE:To analyze effectiveness and economy of domestic vancomycin hydrochloride for injection(trade name:Laikexin)vs. imported vancomycin hydrochloride for injection (trade name:Vancocin) in treatment of intracranial infection induced by MRSA,and to provide decision-making reference for the selection of clinical drugs. METHODS:Clinical data of patients with suspected MRSA intracranial infections receiving Laikexin or Vancocin were collected by retrospective study method from neurosurgery department of our hospital during Jan. 2016 to Jun. 2017,including 115 cases of Laikexin and 42 cases of Vancocin. Using response rate(including clinical cure and clinical improvement) as indexes,cost-effectiveness analysis was performed for Laikexin and Vancocin in the treatment of intracranial infection induced by MRSA by using decision tree model.Sensitivity analysis was conducted for 10% decrease of cost and response rate. RESULTS:Response rate and excepted cost of Laikexin were 85.21% and 13 125.96 yuan,cost-effectiveness ratio(CER) was 15 404.25. Response rate and excepted cost of Vancocin were 78.57% and 15 619.17 yuan,CER was 19 879.31. There was no statistical significance in response rate between Laikexin and Vancocin(P<0.05). There was no difference between sensitivity analysis and cost-effectiveness analysis.CONCLUSIONS:The efficacy of Laikexin and Vancocin in the treatment of MRSA intracranial infection is similar,but the CER of Laikexin is lower than that of Wenkexin.
OBJECTIVE:To analyze effectiveness and economy of domestic vancomycin hydrochloride for injection(trade name:Laikexin)vs. imported vancomycin hydrochloride for injection (trade name:Vancocin) in treatment of intracranial infection induced by MRSA,and to provide decision-making reference for the selection of clinical drugs. METHODS:Clinical data of patients with suspected MRSA intracranial infections receiving Laikexin or Vancocin were collected by retrospective study method from neurosurgery department of our hospital during Jan. 2016 to Jun. 2017,including 115 cases of Laikexin and 42 cases of Vancocin. Using response rate(including clinical cure and clinical improvement) as indexes,cost-effectiveness analysis was performed for Laikexin and Vancocin in the treatment of intracranial infection induced by MRSA by using decision tree model.Sensitivity analysis was conducted for 10% decrease of cost and response rate. RESULTS:Response rate and excepted cost of Laikexin were 85.21% and 13 125.96 yuan,cost-effectiveness ratio(CER) was 15 404.25. Response rate and excepted cost of Vancocin were 78.57% and 15 619.17 yuan,CER was 19 879.31. There was no statistical significance in response rate between Laikexin and Vancocin(P<0.05). There was no difference between sensitivity analysis and cost-effectiveness analysis.CONCLUSIONS:The efficacy of Laikexin and Vancocin in the treatment of MRSA intracranial infection is similar,but the CER of Laikexin is lower than that of Wenkexin.
引文
[1]李聘.医院MRSA感染流行现状及利奈唑胺和万古霉素对其临床疗效和安全性评价[D].合肥:安徽中医药大学,2015.
[2]闫文萍,李俊洁,张敬治,等.耐甲氧西林葡萄球菌的临床感染特点及抗菌药物应用分析[J].实用检验医师杂志,2016,8(3):138-141.
[3]刘伟,朱莹,王开,李光辉.万古霉素给药方案的研究进展[J].中国感染与化疗杂志,2013,13(5):405-408.
[4]刘永芳,吕晓菊.万古霉素的临床应用及耐药现状[J].华西医学,2005,20(1):199-200.
[5]VAN DE BEEK D,DRAKE JM,TUNKEL AR.Nosocomial bacterial meningitis[J].N Engl J Med,2010,362(2):146-154.
[6]赵新亮,申长虹,甄自刚.神经外科术后颅内感染的临床研究[J].中华医院感染学杂志,2006,16(3):277-280.
[7]酒庆华.神经外科术后颅内感染的病原菌及耐药性分析[J].北方药学,2018,15(2):192-193.
[8]张好臣,周正山.神经外科术后颅内感染的相关因素分析[J].中国临床研究,2013,5(13):103-104.
[9]李倩,武元星,唐明忠,等.神经外科患者脑脊液病原菌分布及耐药性变迁[J].中国感染控制杂志,2015,14(3):159-165.
[10]杨洁,陈晴,王磊,等.万古霉素与利奈唑胺治疗神经外科术后颅内感染的疗效、安全性及经济性对比分析[J].中国药房,2018,29(10):1368-1371.
[11]刘贵浩,杨云滨,耿庆山,等.不同级别医疗机构孕产妇就医行为的决策树分析研究[J].中国全科医学,2018,21(17):2101-2105.
[12]范洪伟,李华茵,焦力,等.国产盐酸万古霉素治疗耐药G+球菌感染的有效性和安全性临床研究[J].中国新药杂志,2010,19(5):391-395.
[13]王春革,徐彦贵,王屏,等.运用决策树模型对万古霉素与利奈唑胺治疗皮肤软组织感染进行成本效果分析[J].中国医院药学杂志,2015,35(14):58-62.
[14]魏泽庆,沈萍,陈云波,等.Mohnarin 2010年报告:脑脊液分离细菌的构成及耐药性[J].中华医院感染学杂志,2012,22(3):471-475.
[2]闫文萍,李俊洁,张敬治,等.耐甲氧西林葡萄球菌的临床感染特点及抗菌药物应用分析[J].实用检验医师杂志,2016,8(3):138-141.
[3]刘伟,朱莹,王开,李光辉.万古霉素给药方案的研究进展[J].中国感染与化疗杂志,2013,13(5):405-408.
[4]刘永芳,吕晓菊.万古霉素的临床应用及耐药现状[J].华西医学,2005,20(1):199-200.
[5]VAN DE BEEK D,DRAKE JM,TUNKEL AR.Nosocomial bacterial meningitis[J].N Engl J Med,2010,362(2):146-154.
[6]赵新亮,申长虹,甄自刚.神经外科术后颅内感染的临床研究[J].中华医院感染学杂志,2006,16(3):277-280.
[7]酒庆华.神经外科术后颅内感染的病原菌及耐药性分析[J].北方药学,2018,15(2):192-193.
[8]张好臣,周正山.神经外科术后颅内感染的相关因素分析[J].中国临床研究,2013,5(13):103-104.
[9]李倩,武元星,唐明忠,等.神经外科患者脑脊液病原菌分布及耐药性变迁[J].中国感染控制杂志,2015,14(3):159-165.
[10]杨洁,陈晴,王磊,等.万古霉素与利奈唑胺治疗神经外科术后颅内感染的疗效、安全性及经济性对比分析[J].中国药房,2018,29(10):1368-1371.
[11]刘贵浩,杨云滨,耿庆山,等.不同级别医疗机构孕产妇就医行为的决策树分析研究[J].中国全科医学,2018,21(17):2101-2105.
[12]范洪伟,李华茵,焦力,等.国产盐酸万古霉素治疗耐药G+球菌感染的有效性和安全性临床研究[J].中国新药杂志,2010,19(5):391-395.
[13]王春革,徐彦贵,王屏,等.运用决策树模型对万古霉素与利奈唑胺治疗皮肤软组织感染进行成本效果分析[J].中国医院药学杂志,2015,35(14):58-62.
[14]魏泽庆,沈萍,陈云波,等.Mohnarin 2010年报告:脑脊液分离细菌的构成及耐药性[J].中华医院感染学杂志,2012,22(3):471-475.