南部某區域教學醫院使用Unasyn與Augmentin對於未明示病原體肺炎治療的藥事費用評估

The Evaluation of the Cost with Unasyn and Augmentin in the Treatment of Unspecified Organism Pneumonia in a District Teaching Hospital of South Taiwan

李紋慧(Wen-Hui Lee)

指導教授 ： 吳信昇

高雄醫學大學/藥學院/藥學研究所碩士在職專班/碩士(2005年)

摘要

研究背景 : 肺炎是一種常見的呼吸道感染疾病，在全世界都有相當高的死亡率及罹病率。肺炎的治療主要是使用抗生素療法，而某醫院治療未明示病原體肺炎之用藥，常選擇抗菌範圍較廣之Unasyn或Augmentin作為首選治療藥品。
研究目的 : 探討選擇Unasyn或Augmentin對未明示病原體肺炎治療的有效率，並且計算所用抗生素藥品費用及住院費用來評估其藥事費用。
研究方法 : 本回溯性研究自某區域教學醫院從2004年1月至2004 年12月的病歷篩選出290件肺炎病歷，並依病患住院時肺炎的情況分級成輕、中、重三級。以治療過程抗生素選用條件、治療過程醫療指標條件，依序來評估Unasyn或Augmentin對肺炎治療的有效及無效，並以統計分析其所用抗生素藥品費用和住院日數，評估兩組治療的有效率及藥事費用上是否具有顯著的差異。
研究結果 :在疾病各分級之間Unasyn和Augmentin的治療有效率，p值分別為0.880 ; 0.154 ; 0.642，統計上無明顯的意義。疾病各分級之治療有效率趨勢檢定，Unasyn組的p值為0.031，Augmentin組的p值為0.023，統計學上有顯著意義。在藥事費用評估上，以統計分析其所使用抗生素藥品費用和住院費用，進而估算出有效治療一人之藥事費用，以疾病嚴重度輕、中、重分別在Unasyn組為71,174元; 67,637元; 204,714元，在Augmentin組為70,645元; 113,351元; 140,545元。
結論 : 本研究建立一種簡便可行的抗生素治療未明示病原體肺炎之藥事
費用評估方法。本研究所採用判定治療有效性標準的方法是可靠的。Unasyn和Augmentin治療未明示病原體肺炎的有效率是相同。醫師在治療未明示病原體肺炎，且選擇以抗生素Unasyn或Augmentin來治療時，可將未明示病原體肺炎疾病加以分級，中度以Unasyn治療，輕、重度以Augmentin治療，則以一家區域教學醫院為例，一年推估可節省143萬元。

關鍵字

未明示病原體肺炎

並列摘要

Background:
Pneumonia is a commonly seen respiratory disease, which is one of the leading diseases of morbidity and mortality worldwide. Antibiotics are currently the most popular treatment for pneumonia. Unasyn or Augmentin is usually the first choice to treat unspecified organism pneumonia in a hospital.

Objective:
To explore the effective rates of Unasyn and Augmentin as well as the cost of antibiotics and hospitalization on unspecified organism pneumonia
Method:
The retrospective study was carried out from a district teaching hospital in south Taiwan. 290 medical records of unspecified organism pneumonia were extracted from January 2004 to December 2004. Patients when they were admitted to hospital were classified by their conditions as mild, moderate, and severe. The selecting sequence of antibiotics and results of treatment process were used to determine whether Unasyn or Augmentin had a better therapeutical effect. Statistical analysis on the effective treatments, the cost of antibiotics and days of hospitalization was applied to evaluate whether there were significant differences in the rates of effective treatment and total costs of treatment of the two groups.

Results:
Statistically, no significant differences were shown on the rates of effective treatment between different subgroups of Unasyn and Augmentin. The p value of subgroups of mild, moderate, severe were 0.880, 0.154, 0.642 respectively. Rates of Antibiotics effective treatment between the subgroups of the disease were also examined by trend analysis with significant differences. The p values of trend analysis of Unasyn and Augmentin were 0.031 and 0.023 respectively. The total cost of effective treatment for a person was estimated as subgroups of the disease, the costs of mild, moderate, severe subgroups were shown as NT$71,174, NT$67,637, NT$204,714 in Unasyn group, and NT$70,645, NT$113,351, NT$140,545 in Augmentin group respectively.
Conclusion:
The study established a simple and feasible evaluation method for the total cost of treatment for unspecified organism pneumonia. The criteria of evaluation for effective treatment were reliable. The rates of effective treatment between different subgroups of Unasyn and Augmentin were not different statistically.
If mild and severe subgroups were treated with Augmentin, and moderate subgroup was treated with Unasyn, it was estimated that the total cost of treatment will save about NT$ 1.43 million for a district teaching hospital in one year.

並列關鍵字

Augmentin ； unspecified organism pneumonia ； Unasyn

參考文獻

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