Economic evaluation of procalcitonin-guided antibiotic therapy in acute respiratory infections: a Chinese hospital system perspective
Economic evaluation of procalcitonin-guided antibiotic therapy in acute respiratory infections: a Chinese hospital system perspective
复制标题
降钙素原引导的抗生素治疗急性呼吸道感染的经济评价：中国医院系统的视角
DOI：
10.1515/cclm-2016-0349
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发表时间：
2017
期刊：
影响因子：
--
通讯作者：
P. Schuetz
中科院分区：
文献类型：
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作者：
I. Stojanovic;J. Schneider;Long Wei;Z. Hong;C. Keane;P. Schuetz
摘要背景：成本影响模型表明，在美国，对疑似急性呼吸道感染患者使用基于降钙素原 (PCT) 水平的抗生素管理方案可以节省成本。我们的目标是从中国城市典型医院系统的角度评估急性呼吸道感染 (ARI) 患者采用 PCT 检测的成本影响。方法：为了对 PCT 检测与常规护理进行经济评估，我们根据之前发表的包括中国站点在内的随机试验的患者水平荟萃分析数据建立了成本影响模型。通过将结果应用于中国常见的平均停留时间、费用和实践模式，对数据进行了调整，以适应中国的情况。我们估计了典型医院系统（假设有 1650 个床位）的年度 ARI 就诊率和 ARI 诊断。结果：在住院环境中，16,405 名确诊 ARI 患者的 PCT 指导护理费用与常规护理费用相比接近 110 万元人民币 (CNY)，而常规护理费用约为 180 万元人民币，导致 2015 年中国典型城市医院系统净节省 721,563 元人民币。在 ICU 和门诊环境中，节省费用为 250,699 元人民币，分别为240万元人民币。 PCT引导护理每年总体净节省近340万元。结论：在中国普通医院治疗环境中，ARI PCT 方案可节省大量成本，主要是直接减少不必要的抗生素使用。
Abstract Background: Cost-impact models have indicated that in the USA, the use of antibiotic stewardship protocols based on procalcitonin (PCT) levels for patients with suspected acute respiratory tract infection results in cost savings. Our objective was to assess the cost impact of adopting PCT testing among patients with acute respiratory infections (ARI) from the perspective of a typical hospital system in urban China. Methods: To conduct an economic evaluation of PCT testing versus usual care we built a cost-impact model based on a previously published patient-level meta-analysis data of randomized trials including Chinese sites. The data were adapted to the China setting by applying the results to mean lengths of stay, costs, and practice patterns typically found in China. We estimated the annual ARI visit rate for the typical hospital system (assumed to be 1650 beds) and ARI diagnosis. Results: In the inpatient setting, the costs of PCT-guided care compared to usual care for a cohort of 16,405 confirmed ARI patients was almost 1.1 million Chinese yuan (CNY), compared to almost 1.8 million CNY for usual care, resulting in net savings of 721,563 CNY to a typical urban Chinese hospital system for 2015. In the ICU and outpatient settings, savings were 250,699 CNY and 2.4 million CNY, respectively. The overall annual net savings of PCT-guided care was nearly 3.4 million CNY. Conclusions: Substantial savings are associated with PCT protocols of ARI across common China hospital treatment settings mainly by direct reduction in unnecessary antibiotic utilization.