丹参川芎嗪注射液与参芎葡萄糖注射液治疗脑梗死的成本—效果分析(1)
中图分类号 R956 文献标志码 A 文章编号 1001-0408(2018)04-0487-06
DOI 10.6039/j.issn.1001-0408.2018.04.14
摘 要 目的：评价丹参川芎嗪注射液与参芎葡萄糖注射液治疗脑梗死的有效性和经济性，为临床治疗用药决策提供参考。方法：计算机检索中国知网、中文科技期刊数据库、万方数据知识服务平台和中国生物医学文献数据库，收集丹参川芎嗪注射液或参芎葡萄糖注射液对比复方丹参注射液治疗脑梗死的随机对照试验(RCT)相关文献，基于Meta分析方法间接比较这两种药品的临床疗效，基于国内常规治疗方案和费用水平进行成本测算，并在此基础上进行药物经济学成本-效果分析。结果：共纳入14篇文献，合计1 305例患者。丹参川芎嗪注射液方案与参芎葡萄糖注射液方案的平均总有效率分别为89.63%和94.11%，成本分别为3 855.29和4 198.68元，成本-效果比分别为43.01、44.61；增量成本-效果比为76.65，即参芎葡萄糖注射液方案每增加1%的平均有效率需额外花费76.65元，高于我国居民日均可支配收入(60.18元)。敏感性分析支持成本-效果分析结果。结论：与参芎葡萄糖注射液相比，丹参川芎嗪注射液治疗脑梗死可能更具有成本-效果优势。此结论有待基于RCT的药物经济学评价研究予以验证。
关键词 脑梗死；丹参川芎嗪注射液；参芎葡萄糖注射液；Meta分析；成本-效果分析
ABSTRACT OBJECTIVE： To evaluate the effectiveness and economics of Danshen ligustrazine injection and Shenxiong glucose injection in the treatment of cerebral infarction， and to provide reference for clinical treatment decisions. METHODS： Retrieved from CNKI， VIP， WANFANG DATA and CBM， RCTs about Danshen ligustrazine injection or Shenxiong glucose injection vs. Compound danshen injection in the treatment of cerebral infarction were collected. Clinical efficacies of two drugs were compared indirectly by using Meta-analysis， and the costs were obtained through domestic routine treatment plan and cost level. Based on it， pharmacoeconomic cost-effectiveness analysis was conducted. RESULTS： A total of 14 literatures were included， involving 1 305 patients. Average total response rates of Danshen ligustrazine group and Shenxiong glucose injection group were 89.63% and 94.11%， and the costs were 3 855.29 and 4 198.68 yuan， respectively； cost-effectiveness ratio were 43.01 and 44.61. The incremental cost-effectiveness ratio was 76.65， i.e. Shenqiong glucose injection group needed extra cost of 76.65 yuan for each additional 1% of the average total response rate， which was higher than the daily disposable income of 60.18 yuan in China. Meanwhile， the results of cost-effectiveness analysis were supported by sensitivity analysis. CONCLUSIONS： Compared to Shenxiong glucose injection， Danshen ligustrazine injection is probably more cost-effective for cerebral infarction. Furthermore， the conclusion need to be confirmed by pharmacoeconomics evaluation based on RCTs.
KEYWORDS Cerebral infarction； Danshen ligustrazine injection； Shenxiong glucose injection； Meta-analysis； Cost-effectiveness analysis
據全国第3次死因回顾抽样调查结果显示，我国死亡率最高的疾病是脑血管疾病，其中脑卒中是死亡和致残风险最高的一类脑血管疾病，而脑梗死(缺血性卒中)是临床上最常见的卒中类型[1]。我国每年与脑血管疾病相关的总支出近200亿元[2]。中成药在我国用于治疗脑梗死已有多年历史[3]。研究显示，以具有溶栓降纤、活血化瘀功效的中药有效单体为主要成分的复方制剂，如丹参川芎嗪注射液和参芎葡萄糖注射液，能显著改善患者的神经功能缺损程度，从而有效治疗脑梗死[4-5]。以上两种药品组成相似，适应证和应用范围相似，因此，综合评价和比较二者治疗脑梗死的成本和效果，可为脑梗死治疗的临床用药优选提供一定参考。由于目前尚未见丹参川芎嗪注射液与参芎葡萄糖注射液治疗脑梗死临床疗效的直接比较和药物经济学比较研究，本研究将基于Meta分析方法间接比较这两种药品的临床疗效，并基于国内常规治疗方案和费用水平进行成本测算，在此基础上进行药物经济学成本-效果分析，旨在为脑梗死治疗用药决策提供参考。, http://www.100md.com(田燕 方煜 胡明)
DOI 10.6039/j.issn.1001-0408.2018.04.14
摘 要 目的：评价丹参川芎嗪注射液与参芎葡萄糖注射液治疗脑梗死的有效性和经济性，为临床治疗用药决策提供参考。方法：计算机检索中国知网、中文科技期刊数据库、万方数据知识服务平台和中国生物医学文献数据库，收集丹参川芎嗪注射液或参芎葡萄糖注射液对比复方丹参注射液治疗脑梗死的随机对照试验(RCT)相关文献，基于Meta分析方法间接比较这两种药品的临床疗效，基于国内常规治疗方案和费用水平进行成本测算，并在此基础上进行药物经济学成本-效果分析。结果：共纳入14篇文献，合计1 305例患者。丹参川芎嗪注射液方案与参芎葡萄糖注射液方案的平均总有效率分别为89.63%和94.11%，成本分别为3 855.29和4 198.68元，成本-效果比分别为43.01、44.61；增量成本-效果比为76.65，即参芎葡萄糖注射液方案每增加1%的平均有效率需额外花费76.65元，高于我国居民日均可支配收入(60.18元)。敏感性分析支持成本-效果分析结果。结论：与参芎葡萄糖注射液相比，丹参川芎嗪注射液治疗脑梗死可能更具有成本-效果优势。此结论有待基于RCT的药物经济学评价研究予以验证。
关键词 脑梗死；丹参川芎嗪注射液；参芎葡萄糖注射液；Meta分析；成本-效果分析
ABSTRACT OBJECTIVE： To evaluate the effectiveness and economics of Danshen ligustrazine injection and Shenxiong glucose injection in the treatment of cerebral infarction， and to provide reference for clinical treatment decisions. METHODS： Retrieved from CNKI， VIP， WANFANG DATA and CBM， RCTs about Danshen ligustrazine injection or Shenxiong glucose injection vs. Compound danshen injection in the treatment of cerebral infarction were collected. Clinical efficacies of two drugs were compared indirectly by using Meta-analysis， and the costs were obtained through domestic routine treatment plan and cost level. Based on it， pharmacoeconomic cost-effectiveness analysis was conducted. RESULTS： A total of 14 literatures were included， involving 1 305 patients. Average total response rates of Danshen ligustrazine group and Shenxiong glucose injection group were 89.63% and 94.11%， and the costs were 3 855.29 and 4 198.68 yuan， respectively； cost-effectiveness ratio were 43.01 and 44.61. The incremental cost-effectiveness ratio was 76.65， i.e. Shenqiong glucose injection group needed extra cost of 76.65 yuan for each additional 1% of the average total response rate， which was higher than the daily disposable income of 60.18 yuan in China. Meanwhile， the results of cost-effectiveness analysis were supported by sensitivity analysis. CONCLUSIONS： Compared to Shenxiong glucose injection， Danshen ligustrazine injection is probably more cost-effective for cerebral infarction. Furthermore， the conclusion need to be confirmed by pharmacoeconomics evaluation based on RCTs.
KEYWORDS Cerebral infarction； Danshen ligustrazine injection； Shenxiong glucose injection； Meta-analysis； Cost-effectiveness analysis
據全国第3次死因回顾抽样调查结果显示，我国死亡率最高的疾病是脑血管疾病，其中脑卒中是死亡和致残风险最高的一类脑血管疾病，而脑梗死(缺血性卒中)是临床上最常见的卒中类型[1]。我国每年与脑血管疾病相关的总支出近200亿元[2]。中成药在我国用于治疗脑梗死已有多年历史[3]。研究显示，以具有溶栓降纤、活血化瘀功效的中药有效单体为主要成分的复方制剂，如丹参川芎嗪注射液和参芎葡萄糖注射液，能显著改善患者的神经功能缺损程度，从而有效治疗脑梗死[4-5]。以上两种药品组成相似，适应证和应用范围相似，因此，综合评价和比较二者治疗脑梗死的成本和效果，可为脑梗死治疗的临床用药优选提供一定参考。由于目前尚未见丹参川芎嗪注射液与参芎葡萄糖注射液治疗脑梗死临床疗效的直接比较和药物经济学比较研究，本研究将基于Meta分析方法间接比较这两种药品的临床疗效，并基于国内常规治疗方案和费用水平进行成本测算，在此基础上进行药物经济学成本-效果分析，旨在为脑梗死治疗用药决策提供参考。, http://www.100md.com(田燕 方煜 胡明)
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