低剂量重组组织型纤溶酶原激活剂治疗急性肺血栓栓塞症的卫生经济学评价  

An economic evaluation of low dose recombinant human tissue-type plasminogen activator for the treatment of acute pulmonary thromboembolism

作　　者：武轶群[1] 陶立波[1] 吕聪[1] 胡永华[1] 

机构地区：[1]北京大学公共卫生学院教育部流行病学重点实验室,100191

出　　处：《中华医学杂志》2010年第2期103-106,共4页National Medical Journal of China

摘　　要：目的比较重组组织型纤溶酶原激活剂（rt—PA）50mg／2h和rt—PA100mg／2h两种不同剂量的方案治疗急性肺血栓栓塞症（PTE）的成本和收益。方法利用一项多中心随机对照临床试验的资料，该试验共纳入研究对象118例，其中50mg组65例，100mg组53例，溶栓治疗后14d，右心室功能改善率50mg组为89．1％，100mg组为89．6％，两组差异无统计学意义（χ^2=0．007，P=0．936）；两组出血的不良事件发生率分别为17％和32％，差异无统计学意义（χ^2=3．704，P=0．054）。采用最小成本分析、成本效果分析和预算影响分析的方法对rt—PA50mg／2h（50mg组）和rt—PA100mg／2h（100mg组）两种治疗方案进行卫生经济学评价。结果50mg组治疗方案的成本为6352形人，是100mg组治疗方案的一半。成本效果分析结果显示50mg组和100nag组的成本效果比分别为7129和14179。在达到相同的溶栓疗效时，50mg组比100mg组可节省7050元。采用50mg的治疗方案治疗急性PTE患者，每年将为我国节省4．4亿元的医疗费用。结论50mg rt-PA方案治疗PTE具有良好的有效性和安全性。由于剂量降低所导致的费用降低和潜在的安全性改善，50mg rt—PA低剂量治疗将为患者和社会节省大量的医疗费用，具有较好的卫生经济学优势。Objective To compare and evaluate the cost and effectiveness between recombinant human tissue-type plasminogen activator （rt-PA） 50 mg and 100 mg regimen for the treatment acute pulmonary thromoembolism （PTE）. Methods Based on a randomized clinical trial data, 118 cases were enrolled, 65 cases in group 50 mg and 53 cases in group 100 mg, which showed the similar efficacy and safety of rt-PA 50 mg and 100 mg. Progressive improvement in pulmonary artery obstructions was found to be similarly significant in both treatment groups, but there was no significant differences between the two groups （89. 1% vs 89.6% ,χ^2 =0. 007,P =0. 936）. The rates of adverse events in two groups were same as well （ 17% vs 32% , χ2 = 3. 704 ,P = 0. 054）. We compared the cost directly and the cost-effective rate of the two groups. Based the cost saving of indiviual patient, prevalence rate of acute PTE, and co-pay rate of reimbursement, we calculated the cost saving of societal and payer＇s perspective. Results The cost of group 50 mg is 6352 RMB/person,and the cost of group 100 mg is 12 704 RMB/person. The cost-effect rates of the two groups were 7129 and 14 179 separately. With the same effect, each patient in 50 mg group can save 7050 RMB. If the PTE patients in China were treated with rt-PA 50 mg instead of I00 rag, the society cost saving would be 443 604 624 RMB. Conclusion rt-PA 50 mg/2 h regimen, compared with 100 mg/2 h, can not only provide similar efficacy and safety, but also show a good health economic saving.

关 键 词：经济学 医学 肺栓塞 纤溶酶原激活剂 血栓栓塞 血栓溶解疗法 

分 类 号：R563.5[医药卫生—呼吸系统]