4种非甾体抗炎药治疗类风湿关节炎的成本-效果分析

目的 :探讨 4种口服非甾体抗炎药治疗类风湿性关节炎 6mo的成本和效果。方法 :4 6 1例病人随机分成 4组 ,双氯芬酸组 131例 ,服用双氯芬酸 75～ 10 0mg·d- 1,萘丁美酮组 131例 ,服用萘丁美酮 10 0 0mg·d- 1,美洛昔康组 14 4例 ,服用美洛昔康 15mg·d- 1,塞来昔布组 5 5例 ,服用塞来昔布 2 0 0mg·d- 1,疗程均为 6mo。运用成本 -效果分析对 4组病人进行分析评价。结果 :双氯芬酸、萘丁美酮、美洛昔康、塞来昔布 4组完成疗程病例数分别为12 5 ,12 7,139和 5 5例。在疗程结束时 ,4组间疗效无显著差异 (P >0 .0 5 ) ,塞来昔布组不良反应率明显低于其他 3组 (P <0 .0 1)。 4组总成本分别为(14 0 0±s 32 6 ) ,(15 31± 36 ) ,(2 0 18± 5 2 7) ,(32 2 5±76 7)元 ;成本 -效果比为 (2 0 4 1± 6 12 ) ,(2 5 6 0±6 81) ,(2 985± 70 6 ) ,(4 6 6 7± 1389)元·例 - 1;经敏感度分析后的成本 -效果比为 (1896± 4 5 5 ) ,(2 36 6±6 38) ,(2 6 6 9± 5 89) ,(3978± 96 3)元·例 - 1。结论 :双氯芬酸为治疗类风湿性关节炎的较佳方案 ,在经济许可的情况下 ,偏重考虑药物安全性 ,塞来昔布也是一个较佳选择。

Cost-effectiveness analysis of 4 non-steroidal anti-inflammatory drugs for rheumatoid arthritis

AIM: To evaluate the cost and efficacy of 4 non-steroidal anti-inflammatory drugs (NSAIDs) for the 6 mo treatment of rheumatoid arthritis (RA). METHODS: Four hundred and sixty-one patients were randomly divided into 4 groups. One hundred and thirty-one patients of diclofenac group took diclofenac 75-100mg·d -1 . One hundred and thirty-one patients of nabumetone group took nabumetone 1000mg·d -1 . One hundred and forty-four patients of meloxicam group took meloxicam 15mg·d -1 . Fifty-five patients of celecoxib group took celecoxib 200mg·d -1 . The course of treatment was 6mo. Cost-effectiveness analysis was used to evaluate the cost and efficacy of four groups. RESULTS: There were 125,127,139,and 55 patients finished the study in diclofenac group,nabumetone group,meloxicam group and celecoxib group,respectively.There was no significant difference in the clinical efficacy of four groups ( P > 0.05 ) at the end of the study. The adverse reaction rate of celecoxib group was significantly lower than that of the other 3 groups( P <0.01). The total cost of 4 groups was (1400± s 326),( 1531± 36),(2018±527), and (3225±767) yuan,respectively. The cost-effectiveness ratios of curing per patient were (2041±612),(2560±681),(2985±706), and (4667±1389) yuan,respectively and became (1896±455),(2366±638),(2669±589),(3978±963) yuan after sensitivity analysis. CONCLUSION: Diclofenac is an inexpensive and effective drug for RA. If budget allows, and considering drug safety,celecoxib is also an appropriate choice.