日本快速抗菌药物敏感性检测作为无并发症尿路感染患者即时检验的成本效益分析
Cost-effectiveness analysis of rapid antimicrobial susceptibility testing as a point of care for patients with uncomplicated urinary tract infection in Japan
摘要(中文译文)
针对尿路感染（UTI）患者的经验性抗生素治疗导致了抗生素过度使用或使用不当的增加，这是一个重大的公共卫生问题。引入可快速确定抗菌药物敏感性的即时诊断检测（POCT）预计有助于减少不必要的广谱抗生素使用，并为抗生素管理策略提供可操作的信息。为评估日本尿路感染诊断和治疗策略（包括POCT）的成本效益。从医疗付费方角度构建决策树模型，比较日本社区诊所或医院门诊就诊的单纯性尿路感染患者的三种诊断和治疗策略：（1）POCT指导策略；（2）单纯经验性广谱抗生素治疗；（3）经验性广谱抗生素治疗同时进行传统培养。研究人群分为膀胱炎患者和肾盂肾炎患者。膀胱炎的时间跨度设定为30天，肾盂肾炎为60天。对于膀胱炎患者，与单纯广谱抗生素相比，POCT策略的增量成本效果比（ICER）为每获得一个质量调整生命年（QALY）10,787,224日元；与广谱抗生素加培养相比，为1,552,864日元/QALY。对于肾盂肾炎患者，POCT策略的ICER与单纯广谱抗生素相比为2,362,912日元/QALY，与广谱抗生素加培养相比为222,752日元/QALY。与日本临床实践中常用的广谱抗生素加培养策略相比，POCT策略在膀胱炎和肾盂肾炎患者中显示出潜在的成本效益。这些结果表明，在日本为尿路感染患者引入POCT可能是一种具有成本效益的方法。
Abstract
Empirical antibiotic therapy for patients with urinary tract infections (UTIs) has contributed to the rise of overuse or use of inappropriate antibiotics, which is a significant public health concern. The introduction of point-of-care diagnostic tests (POCTs) for the rapid determination of antimicrobial susceptibility is predicted to help reduce unnecessary broad-spectrum antibiotic use and produce actionable information for an approach to antibiotic stewardship. To evaluate the cost-effectiveness of UTI diagnostic and treatment strategies, including a POCT in Japan. A decision tree model was constructed from a healthcare payer perspective to compare three diagnostic and treatment strategies for patients with uncomplicated UTIs visiting community clinics or hospital outpatient settings in Japan: (1) a POCT-guided strategy; (2) empirical broad-spectrum antibiotic treatment alone; and (3) empirical broad-spectrum antibiotic treatment with concurrent conventional culture. The study population was stratified into patients with cystitis and those with pyelonephritis. The time horizon was set at 30 days for cystitis and 60 days for pyelonephritis. For patients with cystitis, the incremental cost-effectiveness ratio (ICER) for the POCT strategy was JPY 10,787,224 per quality-adjusted life year (QALY) gained compared with broad-spectrum antibiotic agents only, and JPY 1,552,864/QALY compared with broad-spectrum antibiotic agents plus culture. For patients with pyelonephritis, the ICERs for the POCT strategy were JPY 2,362,912/QALY versus broad-spectrum antibiotic agents only, and JPY 222,752/QALY versus broad-spectrum antibiotic agents plus culture. Compared with the broad-spectrum antibiotic agents plus culture strategy, which is common practice in Japan, the POCT strategy demonstrated potential cost-effectiveness for patients with cystitis and pyelonephritis. These results suggest that introducing POCTs for patients with UTIs in Japan may be a cost-effective approach.
如何引用
AMA
Hayato Niiro, Ayumu Yoshida, Fumiko Kino, Fujio Matsuyama, Naoki Tashiro, Tatsunori Murata, et al. Cost-effectiveness analysis of rapid antimicrobial susceptibility testing as a point of care for patients with uncomplicated urinary tract infection in Japan. Journal of medical economics. 2026; doi:10.1080/13696998.2026.2659826.
APA
Hayato Niiro, Ayumu Yoshida, Fumiko Kino, Fujio Matsuyama, Naoki Tashiro, Tatsunori Murata, et al (2026). Cost-effectiveness analysis of rapid antimicrobial susceptibility testing as a point of care for patients with uncomplicated urinary tract infection in Japan. Journal of medical economics. https://doi.org/10.1080/13696998.2026.2659826
GB/T 7714
Hayato Niiro, Ayumu Yoshida, Fumiko Kino, Fujio Matsuyama, Naoki Tashiro, Tatsunori Murata, et al. Cost-effectiveness analysis of rapid antimicrobial susceptibility testing as a point of care for patients with uncomplicated urinary tract infection in Japan[J]. Journal of medical economics, 2026 doi:10.1080/13696998.2026.2659826.
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