背景:约3%的社区获得性细菌性肺炎(CABP)住院患者发生医疗保健相关艰难梭菌感染(HCA-CDI)。验证的Davis风险评分(DRS)表明DRS≥6的患者发生30天HCA-CDI的风险增加。在第三阶段光学CABP研究中,14%接受莫西沙星治疗的DRS≥6的CABP患者发生CDI与0%为奥马环素。这项研究评估了在美国医院中DRS≥6的住院CABP患者中,用奥马环素代替当前指南一致的CABP住院治疗的潜在经济影响。
方法:建立了确定性医疗决策分析模型。模型人群是美国医院中DRS≥6的成年CABP住院患者(100,000名患者)。在准则一致的手臂中,DRS≥6的CABP患者中有14%被认为发展为HCA-CDI,每个花费20,100美元。在omadacycline组中,对整个模型群体计算5天的治疗。
结果:对于DRS≥6的CABP患者,使用奥马环素代替指南一致的CABP住院治疗,估计在美国医院每年可节省5540万美元的成本。
结论:该模拟模型的结果表明,在DRS≥6的住院CABP中,将奥马环素的使用优先于当前的CABP治疗可能会降低归因于HCA-CDI的成本。这些发现并不是奥马环素独有的,并且可以应用于相对于当前CABP住院治疗具有较低HCA-CDI风险的任何抗生素。
BACKGROUND: Approximately 3% of hospitalized patients with community-acquired bacterial pneumonia (CABP) develop healthcare-associated Clostridioides difficile infection (HCA-CDI). The validated Davis risk score (DRS) indicates that patients with a DRS ≥ 6 are at an increased risk of 30-day HCA-CDI. In the phase 3 OPTIC CABP study, 14% of CABP patients with DRS ≥ 6 who received moxifloxacin developed CDI vs. 0% for omadacycline. This study assessed the potential economic impact of substituting current
guideline-concordant CABP inpatient treatments with
omadacycline in hospitalized CABP patients with a DRS ≥ 6 across US hospitals.
METHODS: A deterministic healthcare-decision analytic model was developed. The model population was hospitalized adult CABP patients with a DRS ≥ 6 across US hospitals (100,000 patients). In the
guideline-concordant arm, 14% of CABP patients with DRS ≥ 6 were assumed to develop an HCA-CDI, each costing USD 20,100. In the
omadacycline arm, 5 days of therapy was calculated for the entire model population.
RESULTS: The use of
omadacycline in place of
guideline-concordant CABP inpatient treatments for CABP patients with DRS ≥ 6 was estimated to result in cost savings of USD 55.4 million annually across US hospitals.
CONCLUSIONS: The findings of this simulated model suggest that prioritizing the use of omadacycline over current CABP treatments in hospitalized CABP with a DRS ≥ 6 may potentially reduce attributable HCA-CDI costs. The findings are not unique to omadacycline and could be applied to any antibiotic that confers a lower risk of HCA-CDI relative to current CABP inpatient treatments.