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目的:虽然临床治疗指南不提倡给患有病毒性咽炎的成人患者处方抗生素,但是内科医生还是经常这样做。从支付者角度考察这种医疗行为的经济负担还没有被研究过。本研究的目的就是评估这种行为所产生的费用。方法:从支付者角度研究咽炎管理的疾病负担(Cost-of-Illness)。利用美国国家流动医疗调查(National Ambulatory Medical Care Survey)的数据获得当前成人咽炎流动门诊和抗生素处方的模式。将直接成本和抗生素耐药成本汇总估计咽炎管理的总费用。耐药成本通过建立一个将抗生素使用量与耐药性肺炎链球菌感染相关联的模型计算。依照美国传染病学会(IDSA)临床治疗指南有关咽炎管理的相关规定,对当前医疗模式的成本产出与非抗生素治疗的成本产出进行了比较和敏感度分析。结果:在基础分析中,当前医疗模式的总费用为12亿美元,其中抗生素耐药的成本占总费用的36%(4.26亿美元)。如果遵从IDSA临床治疗指南,医疗成本可以降至5.59亿美元,其中抗生素耐药成本占6.8%(3790万美元)。遵从IDSA临床治疗指南并减少门诊次数的30%,可以降低成本至3.72亿美元,其中抗生素耐药成本占1.4%(530万美元)。采用非抗生素治疗策略可以节省额外的8800万美元成本。结论:当前的医疗模式表明在咽炎治疗中处方抗生素有着广泛的经济影响,给支付者带来很大的经济负担,然而遵从临床治疗指南可以减少耐药性,降低成本。利益相关者、支付者、内科医生和其它医疗提供者应该不断加强对临床治疗指南的依从性,从而降低医疗成本。
Aims: Although clinical guidelines do not advocate prescription antibiotics in adult patients with viral pharyngitis, physicians often do so. Examining the financial burden of such medical behavior from the payer’s perspective has not been studied. The purpose of this study is to assess the cost of such behavior. Methods: The cost-of-illness of pharyngitis management was investigated from the payer’s perspective. Use the data from the National Ambulatory Medical Care Survey to get current patterns of pharyngitis outpatient and antibiotic prescriptions. Aggregate direct costs and antibiotic resistance costs to estimate the total cost of pharyngitis management. Drug resistance costs were calculated by establishing a model that correlated antibiotic use with resistant S. pneumoniae infection. In accordance with the relevant provisions of the American Academy of Infectious Diseases (IDSA) clinical treatment guidelines for pharyngitis management, the current medical model of the cost of output and non-antibiotic treatment cost output were compared and sensitivity analysis. Results: In the underlying analysis, the current total cost of the healthcare model was $ 1.2 billion, of which antibiotic resistance costs accounted for 36% of the total ($ 426 million). If you follow the IDSA guidelines for clinical treatment, medical costs can be reduced to 559 million US dollars, of which antibiotic resistance costs accounted for 6.8% (37.9 million US dollars). Complying with IDSA guidelines for clinical care and reducing outpatient visits by 30% can reduce costs to $ 372 million, of which antibiotic-resistant costs account for 1.4% ($ 5.3 million). Non-antibiotic treatment strategies save an additional $ 88 million in costs. CONCLUSIONS: The current medical model shows that prescription antibiotics have a widespread economic impact on pharyngitis treatments, posing a heavy financial burden to payers. However, following clinical guidelines can reduce drug resistance and reduce costs. Stakeholders, payers, physicians, and other health care providers should continue to be more compliant with the guidelines for clinical care, thereby reducing healthcare costs.