亚胺培南治疗院内常见耐药菌血流感染给药方案结合蒙特卡洛模拟的药物经济学评价

目的 探讨亚胺培南不同给药方案治疗院内常见耐药菌血流感染的经济学效果。方法 调查中山市人民医院2019—2020年应用亚胺培南治疗院内常见耐药菌血流感染病例共151例，按照实际给药分为A方案：0.5 g/次，每12小时给药1次（q12h）；B方案：0.5 g/次，每8小时给药1次（q8h）；C方案：1 g/次，q12h；D方案：1 g/次，q8h；E方案：1 g/次，每6小时给药1次（q6h）。分别进行蒙特卡洛模拟（MCS），计算各方案的累积反应分数（CFR），进行成本效果分析（CEA）。结果 5组方案的成本效果比（C/E）分别为68.5、68.2、100.4、82.6、93.1，以A方案为参照，余下4种方案的增量成本效果比（△C/△E）分别为65.9、845.1、147.2、201.8。结论 C/E最小的B方案对多重耐药鲍曼不动杆菌（MDR-AB）、耐碳青霉烯类铜绿假单胞菌（CRPA）和耐碳青霉烯类肠杆菌科（CRE）的抗菌活性较差，并非院内常见耐药菌血流感染最理想的方案，应结合临床耐药菌种选择给药方案。D方案的药物经济学评价效果优于C方案和E方案，且更多给药频次的E方案并未体现出更高收益。

Pharmacoeconomic evaluation of imipenem against hospital common drug-resistant bacteria blood infection based on Monte Carlo simulation

Objective To evaluate the economic effects of different dosage regimens of imipenem against hospital common drug-resistant bacteria blood infection. Methods A total of 151 cases using imipenem against hospital common drug-resistant bacteria blood infection were investigated in Zhongshan City People''s Hospital from 2019 to 2020 were divided into 5 groups according to actual dosage regimens. group A (0.5 g, q12h), group B (0.5 g, q8h), group C (1 g, q12h), group D (1 g, q8h) and group E (1 g, q6h). These dosage regimens were evaluated with Monte Carlo simulation (MCS), caluated for cumulative fraction responses (CFR), and conducted cost-effectiveness analysis (CEA) respectively. Results the C/E values of the 5 groups were 68.5, 68.2, 100.4, 82.6 and 93.1 respectively. Taking A regimen as the reference, the incremental cost effectiveness ratio(∆C/∆E) of other 4 regimens were 65.9, 845.1, 147.2, and 201.8 respectively. Conclusion Regimen B with the least C/E value had poor antibacterial activity against multi-drug resistant Acinetobacter baumannii (MDR-AB), carbapenem resistant Pseudomonas aeruginosa (CRPA) and carbapenem resistant enterobacteriaceae (CRE), which is not the best regimen for the hospital common drug-resistant bacteria blood infection. Dosage regimen should be selected combinating with clinical drug resistant strains. Regimen D is more effective than regimen C and regimen E, and regimen E with more administration frequency does not show higher benefit.