Analysis On Efficacy And Cost-effectiveness Of Four Treatment Regimens For Bronchiectasis Concurrent Infections

OBJECTTo investigate the clinic efficacy and the pharmacoeconomics evaluation of fourtreatment regimens of bronchiectasis concurrent infections,and to provide proof forrational drug use.METHODS1. This study collected research data of patients with bronchiectasis concurrentinfection between January2013to January2014in The Affiliated Hospital of PutianUniversity,A prospective,randomized,open-label,clinical trial was used in ourstudy,Then these cases were divided into A,B two groups whether the risk factors ofPseudomonas aeruginosa(PA) infection.The patients without the risk factor of PAinfection were selected into group A,and the patients with the risk factors of PAinfection were selected into group B.The patients in group A were been divided intoCefoperazone Sulbactam treatment regimen(ACS subgroup) and MezlocillinSulbactam treatment regimen(AMS subgroup) randomly;and the patients in group Bwere been randomly divided into four subgroups:Cefoperazone Sulbactam+Amikacin treatment regimen(BCA subgroup),Cefoperazone Sulbactam treatmentregimen(BCS subgroup),Mezlocillin Sulbactam+Amikacin treatment regime(BMAsubgroup) and Mezlocillin Sulbactam treatment regimen(BMS subgroup).Andinvestigated the clinical efficacy,laboratory indicators and pathogenic bacteriadetection of four regimens and make a cost-effectiveness analysis of various treatmentregimens.2. To determine the health status and outcomes ways of group A and B.then tobuild a decision tree model and make a pharmacoeconomic analysis.RESULTS 1. The clinical efficacy of ACS subgroup and AMS subgroup were84.0%and77.42%, it’s no statistics comparison meaning between the twosubgroups(P>0.05).The bacterial clearance rate were77.78%and77.27%,thecomparison between subgroups were not statistically significantly(P>0.05).Thenumber of days in hospital of ACS subgroup and AMS subgroup were9.40±2.12daysand11.94±2.52days, the course of treatment of AMS subgroup was longer than ACSsubgroup signifintly(P<0.05).The costs of two subgroups were￥7090.92±1185.36and￥6068.29±899.07,AMS subgroup was cheaper than ACS subgroup signifintly(P<0.05).Thecost-effectiveness ratios of ACS subgroup and AMS subgroup were8441.57and7838.14,It meant that AMS subgroup was better than ACS subgroup inpharcoeconomics through a cost-effectiveness analysis.Sensitivity analysis revealedthat the results were not sensitive.2. The clinical efficacy of BCA subgroup,BCS subgroup,BMA subgroup andBMS subgroup were84.21%,81.82%and80.00%,77.27%,the comparison of themwere no statistically significantly(P>0.05).The bacterial clearance rate in foursubgroups were76.92%,76.47%,78.57%and75.00%,and it is no statisticallysignificantly in four subgroups(P>0.05).the course of treatment of BCAsubgroup,BCS subgroup,BMA subgroup and BMS subgroup were8.53±1.35days,9.82±2.36days,9.55±1.85days,13.45±2.77days and11.94±2.52days,BMS subgroup was longest in four subgroups significantly(P<0.05),and thecomparison of other three subgroups was not statistically significantly(P>0.05).The costs of four subgroups were￥6695.21±768.05,￥7329.79±1327.80,￥5334.00±679.55and￥6597.53±969.31,and BMA subgroup was cheapest,theothers were similar(P>0.05).The cost-effectiveness ratios of four subgroups were7950.61,8958.43,6667.50and8538.28though a cost-effectiveness analysis,BMAsubgroup was lowest in four subgroups.Sensitivity analysis revealed that the resultswere not sensitive.3. To make a cost-effectiveness analysis based on decision tree model,the cost-effectiveness ratios of ACS subgruop and AMS subgroup were7090.92and6068.29in group A.In group B,the cost-effectiveness ratios of BCA subgruop,BCSsubgroup,BMA subgroup and BMS subgroup were6695.20,7329.80,5334.00and6597.54.BMA subgroup was the lowest.The sensitivity analysis shows the outcomesof pharcoeconomic analysis stability.CONCLUSION1. For the patients without the risk factor of PA infection,the clinil efficy andbacterial clearance rate between Cefoperazone Sulbactam and Mezlocillin Sulbactamtreatment regimens was equivalent.Mezlocillin Sulbactam treatment regimen wasmore economil from the perspective of pharcoeconomics. but CefoperazoneSulbactam treatment regimen showed a lower course of treatment.2. For the patients with the risk factor of PA infection,the clinil efficacy andbacterial clearance rate of Cefoperazone Sulbactam+Amikacin,CefoperazoneSulbactam,Mezlocillin Sulbactam+Amikacin and Mezlocillin Sulbactam fourtreatment regimens were similar.The number of days in hospital of MezlocillinSulbactam treatment regimen was longest,but Mezlocillin Sulbactam+Amikacintreatment regimen was most economil in four treatment regimens from theperspective of pharcoeconomics.3. Decision tree model based on bronchiectasis concurrent infection can make apharmacoeconomic analysis intuitively,effectively and applicability.