Economic burden of inpatients infected with Klebsiella pneumoniae carbapenemase

ABSTRACT Objective: To estimate the direct medical costs of drug therapy of Klebsiella pneumoniae carbapenemase (KPC) infection patients in hospital-based context. Methods: A cost-of-illness study conducted with a prospective cohort design with hospitalized adults infected by KPC. Data collection was performed using an instrument composed of sociodemographic data, clinical and prescription medication. Estimates of the direct costs associated to each treatment were derived from the payer's perspective, in the case of federal public hospitals from Brazil, and included only drug costs. These costs were based on the average price available at the Brazilian Price Database Health. No discount rate was used for the cost of drugs. The costs are calculate in American Dollar (US$). Results: A total of 120 inpatients participated of this study. The total drug cost of these inpatients was US$ 367,680.85. The systemic antimicrobial group was responsible for 59.5% of total costs. The direct drug cost per patients infected by KPC was conservatively estimated at nearly US$ 4,100.00, and about of 60% of costs occurred during the period of infection. Conclusion: The findings of our study indicate a thoughtful economic hazard posed by KPC that all healthcare sectors have to face. The increasing worldwide incidence of these bacteria represents a growing burden that most health systems are unable to deal with. There is an imperative need to develop protocols and new antimicrobials to treatment of KPC, aiming to rearrange resources to increase the effectiveness of healthcare services.摘要 研究目的：评估住院场景下肺炎克雷伯菌碳青霉烯酶（Klebsiella pneumoniae carbapenemase, KPC）感染患者的药物治疗直接医疗成本。 研究方法：本研究采用疾病成本研究范式，以前瞻性队列设计开展，纳入感染KPC的住院成年患者作为研究对象。数据采集工具涵盖社会人口学资料、临床信息及处方用药信息三类内容。本研究从支付方视角出发（针对巴西联邦公立医院场景），仅纳入药物成本项以估算各治疗方案对应的直接成本；上述成本基于巴西卫生价格数据库中的平均价格核算，未对药物成本应用贴现率，所有成本以美元（US$）计价。 研究结果：本研究共纳入120名住院患者，其总药物成本为367,680.85美元。全身性抗菌药物类别的成本占总支出的59.5%。经保守估算，单例KPC感染患者的直接药物成本约为4100美元，其中约60%的成本发生于感染期内。 研究结论：本研究结果表明，KPC感染给全球各医疗保健系统均带来了不容忽视的经济风险。此类细菌的全球发病率持续攀升，给多数卫生系统造成了日益加重的负担。当前亟需制定标准化诊疗方案并研发新型抗菌药物以治疗KPC感染，从而优化医疗资源配置，提升医疗服务的整体效能。