抗炎保肝药治疗药物性肝损伤的药物经济学评价  

Evaluation of pharmacoeconomics of oral anti-inflammatory hepatoprotective drugs in the treatment of drug-induced liver injury

作　　者：王爱华[1,2] 唐红波[1,2] 李心蕾[1,2] 张宁[1,2] 冯欣[1,2] 

机构地区：[1]首都医科大学附属北京妇产医院 [2]北京妇幼保健院药剂科,北京100006

出　　处：《胃肠病学和肝病学杂志》2015年第10期1232-1237,共6页Chinese Journal of Gastroenterology and Hepatology

基　　金：国家科技支撑计划项目(2013BAI06B04Y023019)

摘　　要：目的评估临床常用抗炎保肝药治疗药物性肝损伤(drug induced liver injury,DILI)的药物经济学。方法采用决策分析模型,率值参数来源于文献资料的Meta分析结果,依照专家意见制定效果参数,成本参数(药品规格、使用数量和单价)来源于文献资料、专家意见、国家卫生和计划生育委员会与北京市发展和改革委员会新近公布的数据等。观察对象为甘草酸二铵肠溶胶囊(150 mg,tid)、双环醇片(25 mg,tid)、多烯磷脂酰胆碱胶囊(456 mg,tid)、水飞蓟宾胶囊(140 mg,tid)和硫普罗宁肠溶片(200 mg,tid)5种药物治疗疗程均为4周。结果治疗效果以双环醇片组最高(4.51177),优于甘草酸二铵胶囊(4.08885)、硫普罗宁肠溶片(4.13500)、多烯磷脂酰胆碱胶囊(4.13075)和水飞蓟宾胶囊(3.89580);成本-效果比:硫普罗宁肠溶片最低(71.81474),水飞蓟宾胶囊最高(147.48190);与硫普罗宁肠溶片比,双环醇片的增量成本-效果比为244.87723。以显效率作为产出计算,双环醇组显效率(73.10%)高于其他各组,且成本-效果比最低(5.3245),与硫普罗宁肠溶片比,双环醇片的增量成本-效果比为4.6132。敏感度分析证实这一结果可靠。结论双环醇可安全、有效的治疗DILI,且具有成本效果优势。Objective To evaluate the pharmacoeconomics of clinical common hepatoprotectives in the treatment of drug induced liver injury（ DILI）. Methods By applying the model of decision tree analysis in pharmacoeconomics,a retrospective analysis and evaluation were performed on the following five therapeutic schemes. Meta-analysis of RCTs on the five therapeutic schemes was conducted to calculate the key parameters like relevant therapeutic efficacy and safety.The official data,literature or expert opinions were searched to specify other parameters,such as the consumption and unit cost of variety of health resources. The object of observation included Glycyrrhizinate capsule（ 150 mg,tid）,Bicyclol tablets（ 25 mg,tid）,Polyene Phosphatidylcholine capsules（ 456 mg,tid）,Silibinin capsules（ 140 mg,tid） and Tiopronin enteric-coated tablets（ 200 mg,tid）. The treatment course lasted for 4 weeks. Results Bicyclol was the most effective（ 4. 51177）,was better than Glycyrrhizinate capsule（ 4. 08885）,Tiopronin enteric-coated tablets（ 4. 13500）,Polyene Phosphatidylcholine capsules（ 4. 13075） and Silibinin capsules（ 3. 89580）. Meanwhile,the cost-effectiveness analysis of Tiopronin enteric-coated tablets was the lowest（ 71. 81474）,and Silibinin capsules was the highest（ 147. 48190）. The incremental cost-effectiveness ratio（ ICER） of bicyclol was 244. 87723 compared with Tiopronin.The significant efficiency of bicyclol tablets（ 73. 10%） was better than others. Taking the significant efficiency as benefit,the cost / benefit ratio of bicyclol tablets was the lowest（ 5. 3245）. Based on Tiopronin enteric-coated tablet,the ICER of bicyclol tablets was 4. 6132. Sensitivity analysis proved the robustness of the result. Conclusion Bicyclol treatment is a safe and effective choice for DILI,with the advantage of well cost / benefit ratio.

关 键 词：药物性肝损伤 抗炎保肝药 药物经济学 成本效果分析 决策树模型 

分 类 号：R575[医药卫生—消化系统]