国家基本药物中口服降糖药6种用药方案的药物经济学分析

目的：运用药物经济学方法评价国家基本药物中口服降糖药的6种用药方案治疗2型糖尿病的药物经济学效果,为治疗2型糖尿病的药物选择提供参考。方法：将我院2011年3月-2012年8月在门诊治疗的300例2型糖尿病患者平均分为6组,每组50例,分别给予二甲双胍（A组）,格列齐特缓释胶囊（B组）,格列美脲（C组）,二甲双胍＋格列本脲（D组）,二甲双胍＋格列美脲（E组）,二甲双胍＋格列齐特缓释胶囊（F组）进行治疗。观察12周后空腹血糖、餐后2 h血糖及HbA1c,利用成本-效果分析方法,比较其药物经济学效果。结果：治疗12周后,A、B、C、D、E、F组的成本分别为70.56、198.24、136.08、42.84、171.36、233.52元;总有效率分别为86.0%、88.0%、88.0%、84.0%、94.0%、92.0%。经过成本-效果分析,D组C/E为51.00,最小,E组ΔC/ΔE值为12.85,A组ΔC/ΔE值为13.86。结论：从药物经济学的角度分析,D组治疗2型糖尿病方案最经济,但是E组疗效最佳,单一用药方案中A组是最佳选择,在临床治疗中应根据具体情况合理选择。

Pharmacoeconomic analysis on six kinds of regimens using oral antidiabetic drugs in national essential medicines

Objective： To evaluate the pharmacoeconomic effect on the six kinds of regimens using oral antidiabetic drugs in national essential medicines for treating type 2 diabetes mellitus,and provide reference for drug choice.Methods： A total of 300 type 2 diabetic patients in outpatient of our hospital collected from March 2011 to August 2012 were assigned into 6 groups with 50 cases in each group.Metformin（group A）,gliclazide sustained release tablets（group B）,glimepiride（group C）,metformin and glibenclamide（group D）,metformin and glimepiride（group E） and metformin and gliclazide sustained release tablets（group F） were given in different groups,respectively.The treatment effect was observed 12 weeks later by evaluating fasting blood glucose,postprandial 2 h blood glucose and HbA1c.Pharmacoeconomic effect was compared by cost-effectiveness analysis.Results： Twelve weeks after the treatments,the costs of group A,B,C,D,E and F were 70.56 yuan,198.24 yuan,136.08 yuan,42.84 yuan,171.36 yuan and 233.52 yuan,respectively;and the total efficiencies were 86.0%,88.0%,88.0%,84.0%,94.0% and 92.0%,respectively.The value of C/E in group D was 51.00,which was the lowest;while value of ΔC/ΔE in group E was 12.85,ΔC/ΔE in group A was 13.86 by cost-effectiveness analysis.Conclusion： For the treatment of type 2 diabetes mellitus from our pharmacoeconomic analysis,group D（metformin and glibenclamide） was the most economical regimen,while group E（metformin and glimepiride） had the best efficacy,group A（metformin） was the best choice in monotherapy regimen,so reasonable choice of drugs in clinical treatment should be based on the specific situation of the patients.