目的:对于急性胆囊炎,首选的治疗方法是腹腔镜胆囊切除术。在轻度至中度病例中,与不预防相比,使用抗生素预防预防术后感染并发症(POIC)缺乏有关其成本效益的证据.在抗菌素耐药性上升的背景下,成本效益分析(CEA)有明确的理由来确定国家卫生服务资源和抗生素常规使用的最有效利用.
方法:单剂量预防组226例患者中有16例(7.1%)和非预防组231例患者中有29例(12.6%)出现POIC。使用围手术期抗生素预防治疗急性胆囊炎(PEANUTSII)多中心的健康结果数据进行CEA,随机化,开放标签,非自卑,临床试验。成本是用英镑以货币单位衡量的,和有效性表示为在胆囊切除术后的前30天内避免POIC。
结果:此CEA产生的增量成本效益比为-792.70英镑。这表明抗生素预防的适度成本效益比没有预防的成本略低且更有效。考虑到对抗生素的完全依从性,进行了三项敏感性分析,复杂性增加的POIC和断点分析建议在建议系统使用抗生素预防预防POIC时谨慎。
结论:该CEA的结果表明,在英国指南中,有关为轻度至中度急性胆囊炎病例提供抗生素预防的共识更大。
For acute cholecystitis, the treatment of choice is laparoscopic cholecystectomy. In mild-to-moderate cases, the use of antibiotic prophylaxis for the prevention of postoperative infectious complications (POICs) lacks evidence regarding its cost-effectiveness when compared with no prophylaxis. In the context of rising antimicrobial resistance, there is a clear rationale for a cost-effectiveness analysis (CEA) to determine the most efficient use of National Health Service resources and antibiotic routine usage.
16 of 226 patients (7.1%) in the single-dose prophylaxis group and 29 of 231 (12.6%) in the non-prophylaxis group developed POICs. A CEA was carried out using health outcome data from thePerioperative antibiotic prophylaxis in the treatment of acute cholecystitis (PEANUTS II) multicentre, randomised, open-label, non-inferiority, clinical trial. Costs were measured in monetary units using pound sterling, and effectiveness expressed as POICs avoided within the first 30 days after cholecystectomy.
This CEA produced an incremental cost-effectiveness ratio of -£792.70. This suggests a modest cost-effectiveness of antibiotic prophylaxis being marginally less costly and more effective than no prophylaxis. Three sensitivity analyses were executed considering full adherence to the antibiotic, POICs with increased complexity and break-point analysis suggesting caution in the recommendation of systematic use of antibiotic prophylaxis for the prevention of POICs.
The results of this CEA point to greater consensus in UK-based guidelines surrounding the provision of antibiotic prophylaxis for mild-to-moderate cases of acute cholecystitis.