静脉注射和口服铁剂治疗肾性贫血的成本效果分析

目的 比较静脉注射铁剂和口服铁剂治疗肾性贫血的成本效果。 方法 对入选的235 例肾性贫血患者进行随机分组，分别采用静脉注射铁剂和口服铁剂治疗。静脉组根据预计补铁量，于透析过程中进行右旋糖酐氢氧化铁静脉滴注，完成总量后，根据患者铁蛋白和血红蛋白水平，定期给予100 mg维持量。口服组每天口服相当于200 mg铁的琥珀酸亚铁，连续服用。226例完成26周临床观察，静脉组和口服组各113例。以铁剂治疗前后患者血红蛋白和红细胞比容的变化及治疗的好转程度衡量治疗效果，以有效率作为效果指标。治疗成本包括铁剂、红细胞生成素(EPO)、化验检查和不良反应治疗等直接医疗成本，患者的交通、陪护和辅助营养保健品等直接非医疗成本以及患者劳动力损失的间接成本。 结果 26周的研究结果表明，静脉组与口服组人均总治疗费用分别为2.49万 元和2.41万元，差异无统计学意义(P >0.05)；静脉组和口服组治疗总有效率分别为88.5 %和71.68%，差异有统计学意义(P < 0.05)。经成本效果分析，口服组26 周有效治疗1例患者花费3.37万元；静脉组26 周有效治疗1例患者花费2.82万元。 结论 静脉组与口服组比较治疗成本没有差别，疗效更好，静脉组治疗肾性贫血更具成本效果，值得临床推荐。

Cost-effectiveness analysis of oral vs intravenous iron treatment for renal anemia patients

Objective To evaluate the cost-effectiveness of intravenous and oral iron supplements in hemodialysis patients with chronic renal anemia. Methods Two hundred and thirty-five patients with renal anemia were enrolled and randomly divided into intravenous group(n=116) who received iron dextran injection and oral group (n=119) who received ferrous succinate tablets. The dosage of iron dextran was calculated for each patient and was given during each hemodialysis session. After total dosage was finished， 100 mg of maintenance dose was given periodically depending on the levels of ferritin and Hb. The oral group received ferrous succinate tablet equivalent to 200 mg element iron. Two hundred and twenty-six patients finished 26-week treatment and 113 patients in each group. HB and Hct were indexes to evaluate the efficacy of the treatment. The treatment cost included the direct medical costs in iron product， EPO， medical examination and adverse events， and indirect medical costs in traffic， nursing， nutriment and the loss of labor. Results The average treatment cost for each patient was 25 thousand yuan(RMB) and 24.1 thousand yuan(RMB) for intravenous and oral group respectively with no significant difference(P > 0.05). The effective rates were 88.5% and 71.68% for intravenous and oral group respectively with significant difference (P < 0.05). Therefore， average cost per patient for achieving effectiveness was 28.213 thousand yuan(RMB) and 33.683 thousand yuan(RMB) for intravenous and oral group respectively. Conclusions Intravenous iron therapy is more effective in the treatment of renal anemia. There is no significant difference in treatment cost between two groups. Therefore， intravenous iron dextran has greater cost-effectiveness than oral iron in renal anemia， and is worthy to be recommended to clinical application.