血管活性药物治疗肝硬化致食管胃底静脉曲张破裂出血的循证药物经济学评价
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篇名: 血管活性药物治疗肝硬化致食管胃底静脉曲张破裂出血的循证药物经济学评价
TITLE:
摘要: 目的:评价血管活性药物治疗肝硬化致食管胃底静脉曲张破裂出血(EGVB)的临床效果及经济性。方法: 采用循证医学方法,检索国内正式发表的有关血管活性药物治疗肝硬化致EGVB的药物经济学研究文献,筛选文献并进行资料提取后,采用RevMan 5.2软件进行Meta分析,评价不同血管活性药物治疗肝硬化致EGVB的临床效果,并运用药物经济学分析方法评价不同药物方案的经济性。结果:纳入符合标准的文献共10篇。其中,4项研究的止血有效率Meta分析结果显示:奥曲肽组(130例)与生长抑素组(135例)的止血有效率相似[RR=0.89,95%CI(0.80,1.00),P=0.06],但平均止血时间较生长抑素组略长[SMD=0.32,95%CI(0.06,0.58),P=0.01],花费的平均成本较生长抑素组低(3 889元 vs. 4 814元);5项研究的止血有效率Meta分析结果显示:奥曲肽组(146例)的止血效果优于垂体后叶素组(125例)[RR=1.42,95%CI(1.05,1.91),P=0.02],两组成本效果比分别为23.66、3.13;3项研究的止血有效率Meta分析结果显示:生长抑素组(94例)的止血效果与垂体后叶素组(94例)相似[RR=1.06,95%CI(0.87,1.28),P=0.57],但后者花费的成本较前者低(744元 vs. 2 761元)。结论:奥曲肽、生长抑素和垂体后叶素用于肝硬化致EGVB在止血有效率方面比较,除奥曲肽优于垂体后叶素外,其余差异不明显;从经济学角度比较,垂体后叶素组方案最经济,奥曲肽低于生长抑素。临床应根据患者病情、经济情况和药品不良反应选择个体化的药物治疗方案。
ABSTRACT: OBJECTIVE: To evaluate the clinical efficacy and economics of vasoactive drugs for esophageal and gastric varices bleeding (EGVB) causes by cirrhosis. METHODS: By evidence-based medicine method, domestic pharmacoeconomic research literatures were retrieved and screened, Meta-analysis of included literatures were conducted by RevMan 5.2 software; clinical efficacies of different vasoactive drugs for EGVB caused by cirrhosis were evaluated and pharmacoeconomic analysis was done to evaluate the economics of different plans. RESULTS: A total of 10 literatures were included. Meta-analysis of hemostatic efficiency in 4 studies (130 cases of octreotide group, 135 cases of somatostatin group) showed that hemostatic efficiency of 2 groups were similar to each other [RR=0.89, 95%CI (0.80, 1.00),P=0.06], but average hemostatic time of octreotide group was longer than that of somatostatin group [SMD=0.32, 95%CI (0.06,0.58),P=0.01]; the cost of octreotide group was lower than that of somatostatin group (3 889 yuan vs. 4 814 yuan). Meta-analysis of hemostatic efficiency in 5 studies showed that hemostatic efficiency of octreotide group (146 cases) was better than that of pituitrin group (125 cases) [RR=1.42,95%CI(1.05,1.91),P=0.02]; cost-effective ratio of 2 groups were 23.66 and 3.13. Meta-analysis of hemostatic efficiency in 3 studies showed that hemostatic efficiency of 2 groups  (94 cases in each group) were similar to each other [RR=1.06, 95%CI (0.87, 1.28),P=0.57], but the cost of the latter was lower than that of the former (744 yuan vs. 2 761 yuan). CONCLUSIONS: From the aspect of hemostatic efficiency of octreotide, somatostatin and pituitrin for EGVB caused by cirrhosis, octreotide is better than pituitrin, and other difference is not significant. From the aspect of economics, pituitrin is the most economical, and octreotide is lower than somatostatin. Individual therapy plan should be selected according to disease condition, economical situation and ADR.
期刊: 2017年第28卷第2期
作者: 龚金红,杜沈蓥荧,刘广军,杜贯涛,翁春梅
AUTHORS: GONG Jinhong,DU Shenyingying,LIU Guangjun,DU Guantao,WENG Chunmei
关键字: 肝硬化;食管胃底静脉曲张破裂出血;血管活性药物;循证医学;药物经济学
KEYWORDS: Cirrhosis; Esophageal and gastric varices bleeding; Vasoactive drug; Evidence-based medicine; Pharmacoeconomics
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