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。

Systematic Evaluation and Drug Economy Analysis of Peramivir Versus Oseltamivir in the Treatment of Pediatric Influenza

Objective: To systematically evaluate the efficacy and safety of peramivir and oseltamivir in treating children with Influenza, so as to provide evidence-based reference for clinical treatment. Methods: Databases were electronically searched to collect random controlled trials (RCT) about peramivir vs oseltamivir in the treatment of Children with Influenza. Reviewers screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed using the RevMan 5.3 software, and the Tree Age Pro 2011 software was used for drug cost-utility analysis. Results: A total of 17 RCTs involving 2992 patients were included. The results of meta-analysis showed that, compared with the oseltamivir group, the oseltamivir group had (1) significantly shorter duration of fever MD=1.14, 95%Cl (1.11, 1.17), P<0.01], (2) significantly higher effective rate MD=1.14, 95%Cl (1.11, 1.17), P<0.01] and (3) significantly lower incidence of adverse reactions RR=0.65, 95%Cl (0.54, 0.79), P<0.01]. The drug economy study found that the incremental cost-utility ratio (ICER) of peramivir versus oseltamivir was 5719.95 yuan. Conclusions: Peramivir is superior to oseltamivir in the efficacy and safety on treating pediatric influenza. Economically, when the payment threshold is higher than 5719.95 yuan, the increased cost of peramivir will be worthful.