八种方案治疗霉菌性阴道炎的成本效果分析

目的探讨4种治疗方案用于霉菌性阴道炎的药物经济学效果。方法选择2006年1月-2007年6月400例霉菌性阴道炎患者,随机分为8组：A组外用西药治疗,B组口服西药治疗,C组西药外用＋口服治疗,D组外用中药治疗,E组内服中药治疗,F组中药外洗＋内服治疗,G组外用西药＋内服中药治疗,H组外用中药＋内服西药治疗。应用药物经济学中成本-效果分析法是行评价。结果8种治疗方案总有效率分别为75．5％、52．0％、92．2％、75．O％、79．2％、94．0％、96．2％、94．0％;成本／效果（C／E）分别为1．7、0．36、1．6、1．2、．4．5、1．3、2．2、0．54;C、F、G、H组有效率在90％以上,以H组为参照,增加一个效果单位成本-效果比（△C／△E）,分别为-5．1、342．5、74．9。结论A、B、D、E组治疗方法有效率低,H组治疗方案（中药外洗十口服氟康唑胶囊）最理想。     

Critical review of economic evaluations in multiple myeloma: an overview of the economic evidence and quality of the methodology

Continued expansion in the availability of costly alternative therapies in multiple myeloma will enhance the role of economic evaluations in reimbursement decisions and amendments to the treatment guidelines. The quality of economic evaluations should be taken into account by clinicians involved in decision-making. A systematic review and critique of the methodology was performed to assess the trends and quality in economic evaluations in multiple myeloma to date. A literature search was conducted to identify full economic evaluations in multiple myeloma as of December 2009. Details of the economic evaluation methods applied were extracted. Each study underwent a quality assessment based on the Drummond checklist for appraisal of high-quality economic evaluations in health care. Eighteen published economic evaluations were identified. Stem cell transplantation in combination with intensive chemotherapy has been demonstrated to be cost-effective, while interferon alpha is generally ineffective at additional costs. Evaluations have become less frequent in the last decade, especially for newer therapies despite their important contribution to improvements in outcomes. The quality of the methodology applied and its documentation can be improved in many aspects. As users of the results of economic evaluations, clinicians involved in guiding decision-making should be critical of the quality of economic evaluations in multiple myeloma. To ensure access to and identification of high-quality studies, researchers conducting economic evaluations of future advances should strive towards evaluations that fulfil the Drummond criteria and are properly documented.     

药物经济学在临床路径管理中的应用

目的:探讨药物经济学评价方法在临床路径中的应用,正确认识药物经济学评价方法对临床路径的建立和应用的重要意义。方法:描述临床路径概念、发展和现状,结合临床路径具体实践,阐述药物经济学在临床路径管理中的应用。结果与结论:在临床路径制定、实施、付费管理中应结合药物经济学理念和评价结果。药物经济学与临床路径相互结合、相互影响、相互渗透,必将为我国探索出一条科学、合理、经济的医疗卫生改革成功之路。     

药物经济学研究中成本-效果分析法应用现状及存在问题

目的:规范成本-效果分析法(CEA)的应用。方法:以发表的药物经济学评价文献为研究对象,对CEA应用中存在的问题进行统计、分析。结果与结论:CEA是当前应用最为广泛的药物经济学评价方法之一,但应用中存在较多问题,须加以规范。     

运用Markov模型进行药物经济学评价的方法概述及国外研究实例分析

目的:了解国外进行药物经济学评价研究的方法,促进我国药物经济学发展,为临床合理用药提供科学依据。方法:以国外最新乳腺癌治疗方案的药物经济学研究论文为实例,阐述运用Markov模型进行药物经济学评价的方法。结果与结论:借鉴国外分析方法,运用决策分析模型进行药物经济学研究,有利于我国药物经济学的发展。     

3种不同药物对高血压患者降压效果及其消费成本的对比分析

目的：评价临床常用抗高血压药氨氯地平、福辛普利、吲达帕胺治疗高血压的临床效果和经济效益。方法：选择120例高血压病患者随机分为3组,每组40例,分别口服氨氯地平5 mg、福辛普利10 mg、吲达帕胺2.5 mg治疗,并进行药物经济学分析。结果：服药8周后各组患者血压均有明显下降,其中吲达帕胺、福辛普利、氨氯地平治疗高血压总有效率分别为89.4%、86.5%、91.1%,不良反应发生率分别为7.5%、10%、7.5%,成本-效果比分别为5.25、1.65、0.39,氨氯地平、福辛普利相对于吲达帕胺的增量成本-效果比分别为260.89、37.14。结论：吲达帕胺是3种抗高血压药方案中治疗高血压的最佳药物,其消费成本较低,值得在基层医院选用。     

3种方案治疗细菌性阴道病的成本-效果分析

目的：探讨不同用药方案对于治疗细菌性阴道病所产生的经济学效果。方法：180例门诊细菌性阴道病患者随机分为3组．分别给予阴道用乳酸杆菌活菌胶囊10d（A组）,口服奥硝唑6d（B组）,在口服奥硝唑6d后用阴道用乳酸杆菌活茵胶囊10d（C纽）,运用药物经济学方法进行成本-效果分析。结果：3组有效率分别为85．0％、86．7％、96．7％;成本分别为90．1元、98．8元、130．9元;成本-效果比分别为106．00、113．96、135．37;B、C组相对于A组的增量成本一效果比分别为511．76、348．72。结论：C组方案较佳。     

The cost-burden of paediatric pneumococcal disease in Sweden and the potential cost-effectiveness of prevention using 7-valent pneumococcal vaccine

Aims

A cost-effectiveness model was used to estimate the change in disease burden that might be expected if PCV7 was included as part of the routine 3-dose vaccination schedule in Sweden.

Methods

An economic model was populated with data from the main clinical PCV7 efficacy trials, demographic data from government sources, surveillance and epidemiologic data from the US and Nordic region, and average treatment costs, considering the impact of disease on the whole national population.

Results

The model estimated that PCV7 would prevent 18,856 cases of AOM, 684 of pneumonia, 86 of pneumococcal bacteraemia and 21 cases of pneumococcal meningitis in children <10 years, further 221 cases of IPD would be avoided in older children and adults and 397 cases of pneumonia in adults aged 18–39 years. Annually, 4 childhood (<10 years) deaths and 39 deaths in older children and adults would be prevented, resulting in an annual saving of 632 life years. The reduction of cost for the society was estimated to 27.9 (−205, +160) million SEK. The sensitivity analysis showed that it was most sensitive to the efficacy of the vaccine against AOM, the cost of managing infections and the incidence of all disease.

Conclusion

This model demonstrates that implementing a universal vaccine programme in Sweden with PCV7 would be cost-effective with an estimated net reduction of costs for the society.     

帕拉米韦对比奥司他韦治疗儿童流感的系统评价和药物经济性分析

目的：系统评价帕拉米韦对比奥司他韦治疗儿童流感有效性和安全性,为临床治疗提供循证参考。方法：计算机检索中英文数据库,检索帕拉米韦对比奥司他韦治疗儿童流感的随机对照研究（RCT）,筛选文献、提取资料,并评价纳入研究的偏倚风险后,采用RevMan5.3软件进行Meta分析,并采用Tree Age Pro 2011软件运用决策树模型进行药物成本-效用分析。结果：共纳入17个RCT,合计2992例患者。Meta分析结果显示：①帕拉米韦组发热时间[MD=1.14,95%Cl（1.11,1.17）]显著低于奥司他韦组;②帕拉米韦组治疗有效率[MD=1.14,95%Cl（1.11,1.17）]显著高于奥司他韦组;③帕拉米韦组不良反应发生率[RR=0.65,95%Cl（0.54,0.79）]显著低于奥司他韦组。药物经济性研究发现,帕拉米韦对比奥司他韦的增量成本-效用比（ICER）为5719.95元,即帕拉米韦每增加1%的平均有效率较奥司他韦需额外花费5719.95元。结论：帕拉米韦在治疗儿童流感的有效性和安全性方面优于奥司他韦,在经济性评价中,以此药“药到病除”,当支付阈值高于5719.95元时,帕拉米韦增加的成本完全值得。     

地佐辛用于普外科术后镇痛治疗中的药物经济学评价

目的：运用成本-效果分析法评价地佐辛单药治疗方案和多模式镇痛方案用于普外科术后镇痛治疗中的经济性。方法：回顾性分析2016年1月~2018年12月南京鼓楼医院普外科行全身麻醉开腹手术患者627例,按术后镇痛方案分成2组：A 组316例［多模式镇痛：经静脉自控镇痛( PCIA) +氟比洛芬酯注射液］、B 组311例( 地佐辛单药治疗),观察镇痛疗效,运用成本-效果分析法进行药物经济学评价。结果：A组有效率为87.66%,B组有效率为70.42%,差异具有统计学意义（P＜0.05）;A组期望成本为1347.58元,B组期望成本为2406.28元;与A组相比,B组的增量成本-效果比（ICER）为-7515.72元,表示A组相对于B组是绝对优势方案。结论：地佐辛单药治疗方案相比多模式镇痛方案在普外科术后镇痛治疗的应用中,由于药物治疗成本较高,且有效率较低,而不具有药物经济学优势,因此,从医疗卫生系统角度考虑,地佐辛应合理地调整价格,以减少药物治疗成本。