临床药师参与他克莫司个体化给药的成本-效果分析

Cost-effectiveness Analysis of Clinical Pharmacists Participating in Individualized Administration of Tacrolimus

关键词:  特发性膜性肾病  他克莫司  血药浓度  CYP3A5基因型  决策树分析  临床药师

Key words:  idiopathic membranous nephropathy  tacrolimus  blood drug concentration  CYP3A5 genotype  decision tree model  clinical pharmacists

摘要:

目的 对临床药师参与他克莫司治疗特发性膜性肾病（idiopathic membranous nephropathy，IMN）的个体化给药进行药物经济学评价。方法 前瞻性研究纳入南京鼓楼医院2018年1月—2020年6月诊断为IMN的患者60例，随机分为临床药师干预组（30例）和非临床药师干预组（30例），临床药师干预组是在给药前进行药物代谢相关基因CYP3A5检测，而非临床药师干预组在给药前未进行检测；共有42例患者完成整个临床研究，其中临床药师干预组22例，非临床药师干预组20例，用决策树模型分析研究2组治疗方案的成本-效果。结果 治疗6个月后，2组治疗方案中他克莫司血药浓度达标率的差异有统计学意义（P<0.05）；2组治疗方案总有效率的差异无统计学意义；临床药师干预组与非临床药师干预组的期望成本分别为10 261元与9 922元；成本-效果比分别为132.78与198.44。结论 临床药师通过参与CYP3A5基因型检测，指导他克莫司临床个体化给药，提高了他克莫司在IMN患者中血药浓度达标率及治疗有效率，从成本-效果分析结果来看，在他克莫司治疗IMN过程中，临床药师参与CYP3A5基因型检测指导他克莫司个体化给药更经济有效。

Abstract:

OBJECTIVE To evaluate the pharmacoeconomics of clinical pharmacists participating in the individualized administration of tacrolimus in the treatment of idiopathic membranous nephropathy(IMN). METHODS Sixty patients diagnosed with IMN in Nanjing Drum Tower Hospital from January 2018 to June 2020 were included in the prospective study, they were randomly divided into clinical pharmacist intervention group(30 cases) and non clinical pharmacist intervention group(30 cases). The drug metabolism-related gene CYP3A5 was detected in the clinical pharmacist intervention group before administration, while they were not detected in the non-clinical pharmacist intervention group before administration. A total of 42 patients completed the study, including 22 in the clinical pharmacist intervention group and 20 in the non-clinical pharmacist intervention group, using the decision tree model to analysis the cost-effectiveness of treatment regimens of two groups. RESULTS After 6 months of treatment, there was statistical significance in the compliance rate of tacrolimus plasma concentration between the two groups(P<0.05). There was no significant difference in the total effective rate between the two groups. The expected costs of the clinical pharmacist intervention group and the non-clinical pharmacist intervention group were 10 261 yuan and 9 922 yuan, respectively. The cost-effectiveness ratios were 132.78 and 198.44, respectively. CONCLUSION Clinical pharmacists guide the tacrolimus individualization by participating in CYP3A5 gene detection, which improves the compliance rate of tacrolimus blood concentrations in patients with IMN and treatment effectiveness. And cost-effectiveness analysis showed that in the treatment process of tacrolimus for IMN, clinical pharmacists participate in CYP3A5 genotype detection to guide the individualized administration of tacrolimus is more economical and effective.