药物治疗管理服务对脑卒中患者二级预防的成本-效果分析

目的 探讨药物治疗管理（medication therapy management，MTM）服务对脑卒中患者二级预防是否具有成本-效用优势。方法 将首都医科大学附属北京友谊医院2017年9月—2019年8月的脑血管病患者分为MTM组与对照组，3个月后回访，统计患者脑卒中二级预防情况、治疗费用情况、不良反应情况，采用Treeage pro11进行成本-效用分析，设定单次MTM服务收费50.00元，研究周期10年，年贴现率3%，脑卒中复发急性事件的平均住院费用采用《中国卫生健康统计年鉴》2018年卷，患者支付意愿采用3倍10年MTM服务费用6 000.00元作为成本-效果阈值。结果 总计纳入315例患者，其中MTM组158例，对照组157例，失访28人，最终MTM组纳入143例，对照组纳入144例；MTM组服务前后的医疗成本分别是（1 435.03±964.35）元与（819.21±756.86）元，对照组服务前后的医疗成本分别是（1 314.20±931.97）元与（896.53±659.45）元，模拟10年的医疗总成本分别为34 855.82元与24 173.77元，对应的质量调整生命年（quality adjusted life year，QALY）分别为32.69年与17.34年，2组比较，MTM组为优势方案，增量成本效果比为696.08元/QALY。结论 MTM服务作为付费药学服务模式在国外已经取得了较好的成效，但其在国内的开展尚处于初始阶段。本研究以假设MTM为付费服务进行研究，发现临床药师开展MTM服务能够提高脑卒中患者二级预防效果、改善患者预后，且具有经济学优势。

Cost-effectiveness Analysis of Medication Therapy Management Service for Secondary Prevention of Stroke Patients

OBJECTIVE To investigate the cost-effectiveness advantage of medication therapy management(MTM) service in neurology on secondary prevention of stroke patients. METHODS The patients in the department of neurology of Beijing Friendship Hospital, Capital Medical University from September 2017 to August 2019 were divided into MTM group and control group. After returning from the hospital for three months, the secondary prevention, treatment cost and adverse reactions were recorded. Treeage pro 11 was used for cost-effectiveness analysis. A single MTM service charge of 50.00 yuan was set. The study period was 10 years and the annual discount was 3%. The average hospitalization expenses of acute events with recurrent stroke were calculated according to the volume of China Health Statistics Yearbook in 2018. The willingness to pay of patients'' was 3 times that of 10-year MTM service cost of 6 000.00 yuan as the cost-effectiveness threshold. RESULTS A total of 315 patients were included, 158 in MTM group and 157 in control group, and 28 persons lost to follow-up. Finally, 143 cases were included in the MTM group and 144 cases in the control group. The medical costs of MTM group before and after service were(1 435.03±964.35) yuan and(819.21±756.86) yuan respectively, while those of the control group were(1 314.20±931.97) yuan and(896.53±659.45) yuan, respectively. The medical costs in the simulated 10 years were 34 855.82 yuan and 24 173.77 yuan, while the corresponding quality adjusted life year(QALY) were 32.69 years and 17.34 years, respectively. Compared with the two groups, MTM group was the superior scheme, and the incremental cost-effectiveness ratio was 696.08 yuan/QALY. CONCLUSION As a paid pharmaceutical care model abroad, MTM service has achieved good results in pharmaceutical care, and its development in China is still in its infancy. This study assumes that MTM is a paid service for research, and finds that clinical pharmacists to carry out MTM service can improve the secondary prevention effect of stroke patients, improve the prognosis of patients, and has economics advantages.