宁波市初治肺结核患者疗效观察和药物经济学评价

Observation of Curative Effect and Pharmacoeconomic Evaluation of Initially Treated Tuberculosis Patients in Ningbo

关键词:  肺结核  固定剂量复合制剂  疗效  药物经济学

Key words:  tuberculosis  fixed dose compound preparation  curative effect  pharmacoeconomics

摘要:

目的 回顾性分析宁波市结核病市级定点医院治疗初治肺结核患者的疗效、不良反应、耐药等情况，并进行药物经济学评价，为临床制定安全、有效、经济的治疗方案提供科学依据。方法 收集2017年1月—2018年12月该定点医院收治的初治肺结核患者2 455例，根据不同用药方案分为固定剂量复合制剂组（2乙胺吡嗪利福异烟片/4异福片）、四联散装药组（2HRZE/4HR）、混合用药组1（2乙胺吡嗪利福异烟片/4HR）和混合用药组2（2HRZE/4异福片），比较分析4组用药方案治疗初治肺结核患者的痰涂片阴转率、痰培养阴转率、病灶吸收率、空洞闭合率、耐药率、不良反应发生率等情况，并对联合用药方案进行成本-效果分析、以成本为参数的单因素敏感度分析以及采用Monte Carlo迭代模拟，进行概率安全评价，绘制成本-效果可接受曲线。结果 固定剂量复合制剂组、四联散装药组、混合用药组1和混合用药组2在痰涂片阴转率、痰培养阴转率、病灶吸收率及空洞闭合率等方面治疗效果相当，四联散装药组的耐药率和不良反应发生率最高。成本-效果可接收曲线显示，固定剂量复合制剂组对比四联散装药组的意愿支付值和成本效果概率呈递减曲线，在最小单位效果患者意愿支付金额8 000元时，可达到最大成本-效果。结论 固定剂量复合制剂组的成本-效果比最小，该方案相比其他3组用药方案，在较低的意愿支付金额下即可获得最大的成本效果概率，是相对经济、有效的优选方案。

Abstract:

OBJECTIVE To retrospectively analyze the efficacy, adverse reactions and drug resistance of a city-level designated hospital in the treatment of initially treated tuberculosis patients in Ningbo, and to evaluate the pharmacoeconomics, so as to provide a scientific basis for the clinical formulation of safe, effective and economic treatment programs. METHODS A total of 2 455 patients with pulmonary tuberculosis treated in this designated hospital from January 2017 to December 2018 were collected. According to different drug regimens, they were divided into fixed dose compound preparation group(2 tablets of Ethambutol Hydrochloride, Pyrazinamide, Rifampicin and Isoniazid Tablets/4 tablets of Rifampicin and Isoniazid Tablets), quadruple bulk drug group(2HRZE/4HR), fixed dose compound preparation and bulk drug mixed drug group 1(2 tablets of Ethambutol Hydrochloride, Pyrazinamide, Rifampicin and Isoniazid Tablets/4HR) and group 2(2HRZE/4 tablets of Rifampicin and Isoniazid Tablets). The sputum smear negative conversion rate, sputum culture negative conversion rate and focus of patients with pulmonary tuberculosis treated by four drug regimens were compared and analyzed. Absorption rate, cavity closure rate, drug resistance rate, incidence of adverse reactions and cost-effectiveness analysis, single-factor sensitivity analysis with cost as parameter and Monte Carlo iteration simulation were used to evaluate the probabilistic safety of the combined drug regimen, and the cost-effectiveness acceptable curve was drawn. RESULTS Fixed-dose compound preparation group, quadruple bulk drug group, mixed drug group 1 and mixed drug group 2 had similar therapeutic effects in sputum smear negative conversion rate, sputum culture negative conversion rate, focus absorption rate and cavity closure rate, and the drug resistance rate and adverse reactions rate of quadruple bulk drug group were the highest. Cost-effectiveness acceptable curve showed that the willingness-to-pay value and cost-effectiveness probability of fixed dose compound preparation group showed a decreasing curve compared with quadruple bulk charge group. When the minimum willingness-to-pay value was 8 000 Yuan, the maximum cost-effectiveness could be achieved. CONCLUSION The cost-effectiveness ratio of fixed dose compound preparation group is the smallest. Compared with other three groups, this scheme can obtain the maximum cost-effectiveness probability at a lower amount of willingness-to-pay. It is a relatively economic and effective optimal scheme.