帕拉米韦对比奥司他韦治疗流行性感冒合并热性惊厥患儿的药物经济学评价

目的:比较帕拉米韦和奥司他韦治疗流行性感冒(简称流感)合并热性惊厥患儿的有效性和经济性。方法:采用回顾性研究方法,收集2018年12月-2019年3月我院收治的152例流感合并热性惊厥的住院患儿,根据其用药情况分为帕拉米韦组81例,奥司他韦组71例。比较两组患儿的发热缓解时间、用药天数、住院天数、临床效果(以抽搐、咳嗽、鼻塞、流涕、咽痛等进行判定)、皮疹发生率和联用抗生素、中药的患儿例数。采用成本-效果分析法评价两组患儿用药方案的成本-效果比(CER)和增量成本-效果比(ICER)。通过下调15%的药品价格重新计算CER和ICER的方法以及采用有序Logistic回归对效果和多元线性回归对总成本进行敏感性分析。结果:两组患儿的发热缓解时间、用药天数、住院天数、皮疹发生率和联用抗生素患儿占比差异均无统计学意义(P>0.05),但联用中药患儿占比和临床效果差异有统计学意义,帕拉米韦组联用中药患儿占比显著低于奥司他韦组(P<0.001),临床效果显著优于奥司他韦组(P=0.021)。帕拉米韦组和奥司他韦组的总成本分别为5 442.84元/人和5 571.71元/人(P=0.795)、CER分别为54.47和56.51,帕拉米韦组的ICER为-89.38。敏感性分析结果与基础分析结果一致。结论:与奥司他韦相比,帕拉米韦治疗流感合并热性惊厥患儿的效果更好,成本更低。

Pharmacoeconomic Evaluation of Peramivir versus Oseltamivir in the Treatment of Influenza Complicated with Febrile Seizures for Children

OBJECTIVE: To compare the effectiveness and economics of peramivir and oseltamivir in the treatment of influenza complicated with febrile seizures in children. METHODS:In retrospective study,152 children with influenza complicated with febrile seizures were collected from our hospital during Dec. 2018 to Mar. 2019.They were divided into peramivir group(81 cases) and oseltamivir group(71 cases). Fever remission time, medication duration, hospital duration, clinical efficacy(determined by convulsion,cough,nasal obstruction,runny nose,sore throat,etc.),the incidence of rash,the number of children with combined antibiotic and TCM were compared between 2 groups. Cost-effectiveness analysis was used to evaluate costeffectiveness ratio(CER) and incremental cost-effectiveness ratio(ICER) of medication regimen in 2 groups. The sensitivity analysis of the effect and total cost were carried out with Logistic regression and multiple linear regression respectively through CER and ICER calculated by reducing 15% drug price. RESULTS:There was no statistical significance in fever remission time,medication duration,hospitalization duration,the incidence of rash and proportion of children with combined antibiotics between 2 groups(P>0.05). There was statistical significance in proportion of children with combined TCM and clinical effect,and the proportion of children with combined TCM in peramivir group was significantly lower than oseltamivir group(P<0.001). Clinical effect of peramivir group was significantly better than that of oseltamivir group(P=0.021). Total cost of peramivir group and oseltamivir group were 5 442.84 yuan/person and 5 571.71 yuan/person(P=0.795);CER of them were 54.47 and 56.51;ICER of peramivir group was-89.38. The results of sensitivity analysis were consistent with those of basic analysis.CONCLUSIONS:Compared with oseltamivir,peramivir is more effective and less costly for children with influenza and febrile seizures.