Gentamicin每日單劑量與多劑量療法之成本最低化分析

A Cost-minimization Analysis of Gentamicin Comparing Single with Multiple Daily Dosing

林俊杰(Jiun-Jie Lin) ； 古貞庭(Chen-Tin Ku) ； 李摩西(Mo-His Lee)

《台灣醫學》 11卷1期 (2007/01) Pp. 15-21

https://doi.org/10.6320/FJM.2007.11(1).03

摘要

Aminoglycoside（氨基配醣體）普遍運用於治療革蘭氏陰性菌的感染症，給藥的方式醫學界有兩種不同的方式：單一劑量(one-daily aminoglycoside, ODA)與多次劑量(multiple-daily, MDA)。本研究以回溯性收集因感染而住院之病患，使用胺基配醣體治療，本研究從2003年一月一日到六月三十日於豐原醫院之住院病患，病患病歷，進行資料收集、紀錄與統計。分析的參數包括年齡、性別、病患感染部位、住院期間使用費用的數據經由統計進行分析。兩組人員在年齡與性別分布上沒有明顯的差異(p=0.061555)。使用藥物總劑量上ODA平均藥物總劑量1060.53mg；MDA平均藥物總劑量1283.75mg，兩組統計學上有明顯的差異(p=0.013046)。醫療費用細項及醫療費用總額，藥品總額：ODA平均藥品總額708.43元；MDA平均藥品總額856.28元，兩組統計學上有明顯的差異(p=0.013472)。衛材總費用：ODA平均衛材總費用189.44元；MDA平均衛材總費用184.82元，兩組統計學上沒有明顯的差異(p=0.717347)。醫療費用總額：ODA平均醫療費用總額897.88元；MDA平均醫療費用總額1041.1元，兩組統計學上有明顯的差異(p=0.046731)。本研究顯示在藥品總額與醫療費用總額方面ODA少於MDA。在衛材總費用方面兩組ODA花費相當。Aminoglycoside單一劑量的使用顯現出比傳統給藥方式更安全有效，避免無法理解的藥物濃度產生的傷害，可以提供最大的效用，降低毒性，甚至是降低藥物成本，符合藥物經濟學的精神。

關鍵字

gentamycine ； 單次劑量療法 ； 多劑量療法 ； 成本分析

並列摘要

The costs of once-daily aminoglycoside (ODA) versus multiple-daily aminoglycoside (MDA) regimens when these drugs were used to maximize bacterial killing and to reduce the potential for toxicity. The medical records of patients receiving ODA or MDA as antimicrobial therapy for the treatment of infection at a 600-bed Fong-Yuan hospital in Fong-Yuan were retrospectively reviewed. Data were collected for patients treated from January 1, to June 30, 2003. Patient data collected included occurrence of blood, skin/soft tissue, bone/joint, respiratory tract, intra-abdominal and urinary tract. Cost data collected included drug cost, cost of medical paraphernalia, and total cost. The medical records of 210 patients were identified and reviewed; 186 patients were enrolled in the study (90 in the ODA group and 96 in the MDA group).The average total days of therapy was 6.41 for the ODA group and 5.39 for the MDA group. The average drug cost of therapy was NT 708.43 for the ODA group and NT 856.28 for the MDA group. The average total cost was NT 856.28 in the ODA group and NT 1041.10 in the MDA group. The difference in costs between the two groups was significant. There was significant cost difference between ODA and MDA antimicrobial therapy to maximize bacterial killing and to reduce the potential for toxicity.

並列關鍵字

gentamicin ； one-daily dose ； multiple-daily dose ； cost minimization