Editorial Commentary: Life-saving Antimicrobial Drugs: What Are We Doing to Pricing and Availability?
Editorial Commentary: Life-saving Antimicrobial Drugs: What Are We Doing to Pricing and Availability?
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社论评论：拯救生命的抗菌药物：我们在定价和供应方面做了什么？
DOI：
10.1093/cid/ciw153
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发表时间：
2016
期刊：
影响因子：
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通讯作者：
Perfect,JohnR
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作者：
Perfect,JohnR
在本期《临床传染病》的文章中，Merry 和 Boulware 研究了氟胞嘧啶成本加速增长时代隐球菌脑膜脑炎诱导治疗方案的成本效益 [1]。这个富有启发性的演讲强调了传染病医疗保健药品成本变化的领域。经过仔细分析并使用来自非美国来源的数据和一些假设，这些研究人员得出结论，尽管最近氟胞嘧啶的价格上涨，并且在美国等资源可用的社会中，我们可以负担每个质量调整生命年 23 842 美元，但两性霉素 B 和氟胞嘧啶 [2] 的杀真菌性最强且最有效的组合仍然是这种疾病的一种具有成本效益的治疗方法。这些分析极大地帮助我们理解成本和结果的影响，他们的工作强调我们应该不断尝试理解药物成本对患者护理的影响。既没有无限的资金供应，也没有能力将资源浪费在劣质药物治疗上。我们必须密切关注我们的治疗成本，像这篇文章这样的每一项研究都在呼吁我们了解治疗成本与结果之间的关系。对我们来说，提出以下问题很重要：我们现在是否看到抗菌药物成本的“不平衡”，威胁到我们为传染病领域的所有患者提供“最佳”治疗的能力？乙胺嘧啶、氟胞嘧啶、雾化利巴韦林和苄星青霉素等非专利抗菌药物价格大幅上涨，对我们的社会有好处吗？这种上涨是否只是释放了医学界的贪婪？如果不是，如何向社会捍卫这些价格？传染病及其有效药物是否会因为其中一些药物实际上可以治愈疾病而受到经济攻击，从而限制长期用药？或者，抗菌药物在定价上是否处于不利地位，因为这些感染攻击的免疫功能低下的患者数量有限，因此被认为是“利基”药物？究竟什么因素会推动抗菌药物的成本上涨？作为本世纪最卓越的医学成就之一的丙型肝炎管理为何受到攻击？目睹一种未知病毒从识别到诊断再到治愈，只用了25年时间，真是令人难以置信；然而，这一非凡的成就现在却陷入了对新的、非常有效的技术的成本和可用性的沮丧之中。
In their article in this issue of Clinical Infectious Diseases, Merry and Boulware examine the cost-effectiveness of a cryptococcal meningoencephalitis induction therapeutic regimen in the era of accelerated costs for flucytosine [1]. The arena of changing healthcare drug costs in infectious diseases is highlighted by this illuminating presentation. In a careful analysis and using data with some assumptions from non-US sources, these investigators come to the conclusion that the most fungicidal and effective combination of amphotericin B and flucytosine [2] is still a cost-effective therapy for this disease despite recent price increases in flucytosine and that in resource-available societies such as the United States, we may afford the $23 842 per quality-adjusted life-year. These analyses critically help us understand the implications of costs and outcomes, and their work emphasizes that we should constantly attempt to appreciate the implications of drug costs on patient care. There is neither an unlimited supply of money nor the ability to waste resources on inferior drug regimens. We must keep a pulse on the cost of our therapies, and each study like this particular article is a call to arms for us to understand the implications of costs for our therapies in relationship to outcome.It is important for us to ask the following questions: Are we now seeing an “imbalance” in the costs of antimicrobial drugs that threatens our ability to deliver the “best” therapy for all patients within the infectious diseases space? Is it good for our society to see an explosion of price elevations for generic antimicrobial drugs such as pyrimethamine, flucytosine, aerosolized ribavirin, and benzathine penicillin? Is this rise simply unleashed greed on the medical community and, if not, how are these prices defended to society? Are infectious diseases and their effective drugs being financially attacked because some of these drugs actually cure the disease, thus limiting long-term drug use? Alternatively, are the antimicrobial agents disadvantaged in pricing because these infections attack a limited number of immunocompromised patients and are thus considered “niche” drugs? What really should drive the costs of antimicrobial agents? Why has hepatitis C management, which is one of the most remarkable medical achievements in this century, come under attack? It is incredible to witness an unknown virus go from identification to diagnosis to cure in 25 years; yet, this remarkable achievement is now mired in frustrations about costs and availability for the new, very effective