在患有败血症或败血性休克的重症患者中,以数据驱动的个性化抗生素剂量的成本效益
Hana M Broulikova1, Jacqueline Wallage2, Luca Roggeveen2
1Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, Van der Boechorststraat 7, Amsterdam, 1081 BT, the Netherlands. h.m.broulikova@vu.nl.
Journal of clinical monitoring and computing
|January 24, 2025
概括
对患有败血症的重症患者的精确抗生素剂量显示出更高的成本和没有显著的成本效益. 这种数据驱动的方法虽然有助于实现目标,但不建议广泛实施.
科学领域:
- 关键护理医学 关键护理医学
- 药物经济学 药物经济学
- 传染性疾病 传染性疾病
背景情况:
- 败血症和败血性休克是危及生命的疾病,需要有效的抗生素治疗.
- 精确剂量定量旨在优化危急病患者的抗生素水平.
- 经济评估对于评估新干预措施的价值至关重要.
研究的目的:
- 对数据驱动的,基于模型的精确抗生素剂量与重症患者的常规护理进行经济评估.
- 为了比较成本,质量调整后寿命年 (QALY),死亡率和药理动力学目标的实现.
主要方法:
- 经济评估与AutoKinetics随机对照试验一起进行.
- 衡量成本的社会视角.
- 对不确定性分析的双变量回归和引导.
- 增量成本效益比率 (ICER) 的计算.
主要成果:
- 干预组的成本较高 (42,684欧元与39,475欧元),但死亡率较低 (42%与49%),QALYs更多 (0.184与0.153).
- 在干预组中,药理动力学目标的实现明显高于干预组 (69%对48%).
- ICER表示需要大量投资来挽救生命或获得QALY;成本效益概率通常低于60%.
结论:
- 在AutoKinetics试验中实施的数据驱动的个性化抗生素剂量不是一个具有成本效益的干预措施.
- 目前的精确剂量策略需要进一步优化,以证明在重症患者中具有经济价值.
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