A Review of Infectious Diseases Guidelines' Incorporation of Economic Evidence.
A Review of Infectious Diseases Guidelines' Incorporation of Economic Evidence.
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对传染病指南纳入经济证据的审查。
DOI：
10.1093/cid/ciac357
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发表时间：
2022
期刊：
影响因子：
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通讯作者：
Kapadia,ShashiN
中科院分区：
文献类型：
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作者：
King,Madeline;Kapadia,ShashiN
致编辑-从成本效益的角度来看，Rajasingham等人得出结论，治疗艰难梭菌感染（CDI）的首选方案是非达霉素治疗非重度CDI，万古霉素治疗重度CDI，非达霉素治疗首次复发，粪便微生物群移植治疗后续复发[1]。这是基于个人和支付者愿意支付31751美元/质量调整生命年（QALY）的前提，这是使用甲硝唑治疗非重度CDI和万古霉素治疗重度CDI和所有复发的增量成本。这项研究的方法似乎是合理的。然而，作者认为，任何干预措施，成本低于10万美元每QALY是具有成本效益的。他们没有对这一临界值做出解释，这一临界值位于此类分析通常选择的量的上限[2]。当个人和支付者愿意支付的每QALY成本在20世纪90年代初首次得出时，只有有限的超昂贵药物和技术。临床医生可以推荐的超昂贵药物和技术的数量正在迅速增加。如果我们选择采用任何符合“成本效益”这一广泛定义的产品，那么制造商降低价格的动力将有限，医疗保健成本将超过即使是最富裕的国家也能承受的范围。
TO THE EDITOR—From a cost-effectiveness point of view, Rajasingham et al conclude that the preferred regimen for treatment of Clostridiodes difficile infection (CDI) is fidaxomicin for nonsevere CDI, vancomycin for severe CDI, fidaxomicin for first recurrences, and fecal microbiota transplant for subsequent recurrences [1]. This is based on the premise that individuals and payers are willing to pay $31751 dollars per quality-adjusted life-year (QALY), the incremental cost of this regimen over using metronidazole for nonsevere CDI and vancomycin for severe CDI and for all recurrences. The methodology of this study appears to be sound. However, the authors assume that any intervention that costs less than $100 000 per QALY is cost-effective. They do not provide an explanation for this cutoff, which is at the upper end of the amounts typically chosen for such analyses [2]. When the cost per QALY that individuals and payers would be willing to pay was first derived in the early 1990s, there were limited ultraexpensive drugs and technologies. The number of ultraexpensive drugs and technologies that clinicians can recommend is rapidly increasing. If we choose to adopt any that meet this broad definition of “cost-effective,” there will be limited incentive for manufacturers to decrease prices and the cost of healthcare will increase beyond what even the wealthiest of nations can afford.