不同方案治疗轻中度支气管哮喘的疗效与经济学分析

目的 对轻中度支气管哮喘（简称哮喘）不同的治疗方案进行比较,探寻治疗成本-效果比相对较低的方案.方法 把哮喘患者分为5组,A组吸入沙美特罗氟替卡松粉吸入剂（舒利迭）50μg/250μg,每日1～2次;B组使用氟替卡松气雾剂125μg/喷,每次吸用2～3喷,每日2次;C组口服茶碱缓释片,0.1 ～0.2g,每日2次;D组口服小剂量强的松,5～10 mg,每日1次;E组口服孟鲁司特5～10 mg,每日1次.比较各组患者病情改善、医疗费用及总费用情况,进行医疗成本-效果分析.结果 A组完全控制率及有效（完全控制＋部分控制）率最高,分别达到68.0％和84.0％,B组分别为45.8％和70.8％,不良反应发生例数以A组和E组最低,均为16.0％,D组不良以应发生率最高,为72.7％.A组间接药费最低,无住院费用,人均间接经济损失也最低.B组费用-效果比最低,E组最高.结论 对于部分支气管哮喘轻中度发作患者,考虑可以采用单纯吸入氟替卡松方案,能够降低医疗费用,达到比较满意的控制效果.

Economic analysis of the effectiveness of different treatment regimens with mild to moderate bronchial asthma

Objective To compare the effectiveness of treatment of patients with mild to moderate bronchial asthma（ referred to as asthma） which adopted different treatment regimens and make economic analysis to seek better method that costs-effectiveness rate is relatively low. Methods The patients with asthma were divided in 5 groups. Fluticasone salmeterol inhalation powder（Seretide） 50 μg/250μg was inhaled in group A, 1-2 times everyday;Fluticasone aerosol 125 μg/spray was inhaled in group B, 2 to 3 sprays every time, twice daily ;Theophylline Sustained-release tablets were taken in group C,0.1 -0.2 g,2 times a day; Low-dose prednisone was used in group D, 5 -lOmg, once daily; Montelukast is taken in group E ,5 -10 mg, once daily. The patients＇ condition improvement, medical expenses and the total expenses of each group were recorded, and then the medical cost-effectiveness analysis was conducted. Results The complete control rate and effective control（complete control ＋ partial control） rate in group A reached 68.0% and 84.0% with the highest rates, were respectively 45.8% and 70.8% in group B. The lowest incidence of side effects occurred in group A and group E with both 16.0% ,the highest incidence of side effects was 72.7% in group D. The indirect cost of drugs in group A was lowest,with no in-hospital costs and the lowest per capita indirect economic losses. The medical cost-effectiveness rate was lowest in Group B, highest in group E. Conclusion For some patients with mild to moderate asthma, inhaled fluticasone program is appropriate to reduce health care costs and achieve satisfactory effect.