目的:治疗指南是艰难梭菌感染(CDI)处方实践的关键驱动因素,但是关于最佳实践的建议可能会有所不同。我们进行了成本效用分析,以比较欧洲临床微生物学和传染病学会(ESCMID)指南推荐的治疗途径与美国国家健康与护理卓越研究所(NICE)指南提出的途径。从英国国民健康服务(NHS)的角度来看。
方法:采用决策树建模方法来反映ESCMID和NICE指南中概述的CDI治疗途径。经历CDI感染的患者每次感染接受多达三种治疗以实现应答,并且随后可能经历多达两次复发。患者人口统计数据,治疗反应,复发,公用事业,CDI相关的死亡率和费用取自已发表的文献。
结果:与NICE治疗途径相比,ESCMID治疗途径具有成本效益,每获得质量调整生命年(QALY)阈值为20,000英镑,增量成本效益比(ICER)为4931英镑。成本效益由指标感染建议的差异驱动(ESCMID建议非达霉素作为一线治疗,而NICE建议万古霉素)。模型结果对情景和敏感性分析中调查的输入变化具有鲁棒性,和概率敏感性分析(PSA)表明,与NICE治疗策略相比,ESCMID指南治疗策略具有100%的成本效益可能性.
结论:与NICE指南相比,从英国NHS的角度来看,ESCMID指南中关于CDI指数治疗的建议代表了最具成本效益的医疗资源使用.
OBJECTIVE: Treatment guidelines are key drivers of prescribing practice in the management of Clostridioides difficile infection (CDI), but recommendations on best practice can vary. We conducted a cost-utility analysis to compare the treatment pathway recommended by the European Society of Clinical Microbiology and Infectious Diseases (
ESCMID) guideline with the pathway proposed by the National Institute for Health and Care Excellence (NICE) guideline, from the perspective of the UK National Health Service.
METHODS: A decision tree modelling approach was adopted to reflect the treatment pathway for CDI as outlined in
ESCMID and NICE guidelines. Patients experiencing a CDI infection received up to three treatments per infection to achieve a response and could subsequently experience up to two recurrences. Data on patient demographics, treatment response, recurrence, utilities, CDI-related mortality, and costs were taken from published literature.
RESULTS: The
ESCMID treatment pathway was cost-effective versus the NICE treatment pathway at a threshold of £20 000 per quality-adjusted life year gained, with an incremental cost-effectiveness ratio of £4931. Cost-effectiveness was driven by differences in index infection recommendations (ESCMID recommends fidaxomicin as first-line treatment whereas NICE recommends vancomycin). The model results were robust to variations in inputs investigated in scenarios and sensitivity analyses, and probabilistic sensitivity analysis demonstrated that the
ESCMID guideline treatment strategy had a 100% likelihood of being cost-effective versus the NICE treatment strategy.
CONCLUSIONS: Compared with the NICE guideline, the
ESCMID guideline recommendations for treating an index CDI represent the most cost-effective use of healthcare resources from the perspective of the UK National Health Service.