Drug utilization pattern and cost for the treatment of severe sepsis and septic shock in critically ill cancer patients
Drug utilization pattern and cost for the treatment of severe sepsis and septic shock in critically ill cancer patients
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DOI：
10.1007/s11096-013-9860-2
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发表时间：
2013-12-01
影响因子：
2.4
通讯作者：
Hawari, Feras
中科院分区：
文献类型：
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作者：
Nazer, Lama;Al-Shaer, Mohammad;Hawari, Feras
背景
癌症患者发生败血症的风险较高。据我们所知，尚无研究评估严重败血症和感染性休克的癌症患者所使用的药物类型及其相关费用。
目的
描述严重败血症和感染性休克的癌症患者的药物使用模式和药物费用。
场所
一家综合性教学癌症中心的拥有12张床位的内科/外科重症监护病房（ICU）。
方法
对2010年1月至12月在ICU接受治疗的严重败血症或感染性休克的癌症患者进行回顾性队列研究。利用ICU败血症数据库确定患者。记录患者的人口统计学资料和特征。此外，确定所开药物的数量和类型、每种药物的总费用、感染类型以及培养结果。
主要观察指标
主要观察指标是所使用的药物类别以及药物费用。
结果
在研究期间，确定了116例病例。就诊时，急性生理与慢性健康状况评分II（APACHE II）平均得分为21.8（标准差±7.8），30例（25.9%）患者有中性粒细胞减少症，94例（81%）患者培养结果呈阳性。该组患者所开药物的总费用为291,030欧元。每位患者平均用药数量和每位患者平均总费用分别为11.7（标准差±4.7）和2,509欧元（标准差±2,844）。最常使用的药物类别分别是抑酸治疗药物、糖肽类、青霉素/头孢菌素类和血管升压药，分别有113例（97%）、104例（89.7%）、103例（88.9%）和102例（88%）患者使用。药物费用最高的是抗真菌药（平均每位患者1,288欧元）和集落刺激因子（平均每位患者829欧元），分别有55例（47.4%）和37例（31.9%）患者使用。与幸存者相比，非幸存者的药物费用更高（3,664欧元对1,430欧元，p = 0.0001），培养结果呈阳性的患者与培养结果呈阴性的患者相比药物费用更高（3,198欧元对1,865欧元，p = 0.0004）。
结论
在严重败血症和感染性休克的癌症患者中，使用多种药物且费用较高。
Background Cancer patients are at high risk for developing sepsis. To our knowledge, there are no studies that evaluated the type of medications utilized and the associated cost in cancer patients with severe sepsis and septic shock. Objective To describe the drug utilization pattern and drug cost in the treatment of cancer patients with severe sepsis and septic shock. Setting 12-bed medical/surgical intensive care unit (ICU) of a comprehensive teaching cancer center. Methods A retrospective cohort study of cancer patients with severe sepsis or septic shock who were treated in the ICU between January and December, 2010. The ICU sepsis database was used to identify patients. The patient demographics and characteristics were recorded. In addition, the number and type of prescribed medications, total cost for each medication, type of infection, and culture results were determined. Main outcome measure The main outcomes were the type of medication classes utilized and the cost of the medications. Results During the study period, 116 cases were identified. Upon presentation, the mean Acute Physiology and Chronic Health Evaluation II (APACHE II) score was 21.8 (SD +/- 7.8), 30 (25.9 %) patients had neutropenia, and 94 (81 %) had positive cultures. The total cost of the medications prescribed for this cohort of patients was 291,030 Euro. The mean number of medications prescribed per patient and the mean total cost per patient were 11.7 (SD +/- 4.7) and 2,509 Euro (SD +/- 2,844), respectively. The most commonly prescribed medication classes were acid suppressive therapy, glycopeptides, penicillins/cephalosporins and vasopressors prescribed in 113 (97 %), 104 (89.7 %), 103 (88.9 %), and 102 (88 %) patients, respectively. The highest medication costs were associated with antifungals (mean 1,288 Euro/patient) and colony stimulating factors (mean 829 Euro/patient), prescribed in 55 (47.4 %) and 37 (31.9 %) patients, respectively. Medication costs were higher in non-survivors, compared to survivors (3,664 Euro vs. 1,430 Euro, p = 0.0001), and in patients with positive cultures, compared to patients with negative cultures (3,198 Euro vs. 1,865 Euro, p = 0.0004). Conclusion In cancer patients with severe sepsis and septic shock, multiple medications are prescribed which are associated with high cost.