阿莫西林克拉维酸钾和莫西沙星治疗社区获得性肺炎的药物经济学评价

Pharmacoeconomic Evaluation of Amoxicillin-clavulanate versus Moxifloxacin in the Treatment of Community-acquired Pneumonia

关键词:  阿莫西林克拉维酸钾  莫西沙星  药物经济学

Key words:  amoxicillin-clavulanate  moxifloxacin  pharmacoeconomics

摘要:

摘要：目的 对比阿莫西林克拉维酸钾与莫西沙星治疗社区获得性肺炎（CAP）的经济性，为CAP初始经验治疗提供决策依据。方法 采用回顾性研究方法，收集2022年1月至2022年12月于XXX医院确诊为CAP的住院患者病历资料，按照治疗方案不同分为A组（阿莫西林克拉维酸钾）95例及B组（莫西沙星）106例，使用TreeAge Pro 2022软件构建决策树模型对两种药品治疗CAP进行成本-效果及成本-效用分析。以两种方案总平均成本为意愿支付（WTP）阈值，采用单因素敏感性分析及概率敏感性分析验证结果的稳健性。结果 A组有效率为82.11%，期望成本为523.34元，成本-效果比为6.37；B组有效率为93.40%，期望成本为252.93元，成本-效果比为2.71。与A组相比，B组人均增量成本为-270.41元，人均增量效果为0.0840 QALDs，成本效果比为-3218.71元/QALD，远低于WTP阈值。单因素敏感性分析结果显示，阿莫西林克拉维酸钾转好的成本、阿莫西林克拉维酸钾无效的成本及莫西沙星转好的概率对结果影响相对较大，但不足以翻转结果。概率敏感性分析结果显示，WTP阈值在0~50000区间内，B组具有的经济性概率均大于A组。结论 与阿莫西林克拉维酸钾相比，莫西沙星治疗CAP更具经济性。

Abstract:

ABSTRACT: OBJECTIVE To compare the economics of amoxicillin-clavulanate versus moxifloxacin in the treatment of community-acquired pneumonia (CAP) and to provide a basis for decision-making in the initial empirical treatment of CAP. METHODS A retrospective study was conducted to collect medical records of inpatients diagnosed with community-acquired pneumonia at the Xiamen Fifth Hospital from January 2022 to December 2022. The patients were divided into 95 cases in group A (amoxicillin-clavulanate) and 106 cases in group B (moxifloxacin) according to the treatment regimen, and a decision tree model was constructed using TreeAge Pro 2022 software to conduct cost-effectiveness and cost-utility analyses of the two medications for the treatment of CAP. The total average cost of the two treatment schemes was used as the willingness-to-pay (WTP) threshold, and the robustness of the results was verified using one-way sensitivity analysis and probabilistic sensitivity analysis. RESULTS Group A had an effective rate of 82.11%, an expected cost of 523.34 yuan, and a cost-effectiveness ratio of 6.37; Group B had an effective rate of 93.40%, an expected cost of 252.93 yuan, and a cost-effectiveness ratio of 2.71. The incremental cost of Group A versus Group B was -270.41 yuan, respectively. The incremental effectiveness was 0.0840 QALDs， respectively. The incremental cost-effectiveness ratio was -3218.71 yuan/QALD, which was lower than the value of WTP. Results of one-way sensitivity analysis showed that the cost of amoxicillin-clavulanate treatment after effective，the probability of ineffectiveness after amoxicillin-clavulanate treatmentand the probability of effectiveness after moxifloxacin treatment had the greatest influence on the results, but ICER was always greater than the WTP within the floating range of each parameter. The results of the probabilistic sensitivity analysis showed that Group B had a greater probability of economy than Group A for conditions with WTP thresholds in the interval of 0 to 50,000. CONCLUSION Compared to amoxicillin-clavulanate, moxifloxacin is more economical for the treatment of CAP.