质子泵抑制剂预防高催吐风险化疗所致恶心呕吐的卫生技术评估  

Health Technology Assessment of Proton Pump Inhibitor for Prevention of Nausea and Vomiting Following High Emetic Risk Chemotherapy

作　　者：魏娜[1] 郑斌[1] 庄茜[1] 蔡鸿福[1] 李娜[1] 杨菁[1] 刘茂柏[1] WEI Na;ZHENG Bin;ZHUANG Qian;CAI Hong-fu;LI Na;YANG Jing;LIU Mao-bai(The pharmacy of Fujian Medical University Union Hospital,Fuzhou 350001,China)

机构地区：[1]福建医科大学附属协和医院药学部,福建福州350001

出　　处：《海峡药学》2022年第1期105-112,共8页Strait Pharmaceutical Journal

基　　金：福建省教育厅社科类项目(JAS19105);中国药学会科技开发中心(CMEI2020SJYJ00101)。

摘　　要：目的系统评价质子泵抑制剂(proton pump inhibitor,PPI)预防高催吐风险化疗所致恶心呕吐的有效性和安全性,并分析其经济性。方法应用卫生技术评估方法,收集随机对照试验(randomized control trials,RCTs),通过Meta分析评价其有效性、安全性,并进行成本-效果分析。结果最终纳入8个RCTs进行Meta分析,结果显示:使用激素的止吐方案中,PPI联用在总控制有效率方面优于常规止吐方案;无使用激素的止吐方案中,PPI联用并不优于常规止吐方案。而对于PPI联用在预防急、慢性恶心、呕吐的有效率并不优于常规止吐方案。在其他不良反应发生率方面,无统计学差异。PPI联合止吐方案与常规止吐方案在控制恶心、呕吐的成本-效果分析显示,增量成本效果比分别为7.82、7.48,敏感性分析显示结果稳定。结论PPI不推荐用于高致吐化疗所致恶心呕吐预防,对于联合应用较大剂量激素的止吐方案或合并有应激性溃疡高危因素,可应用PPI且应尽量给予口服剂型。OBJECTIVE To systematically review the effectiveness and safety of proton pump inhibitor(PPI)combined with antiemetic drugs for prevention of nausea and vomiting following high emetic risk chemotherapy,and evaluate the cost of the two groups.METHODS Health technology assessment was used to collect randomized control trials(RCTs).Meta analysis was performed to obtain analysis results of effectiveness and safety,and cost-effectiveness analysis was performed.RESULTS A total of eight RCTs were included.The results of meta-analysis showed that among the combined antiemetic drugs with corticosteroids,the total control effective rate of PPI combination was superior to that of conventional antiemetic drugs.Among the combined antiemetic drugs without corticosteroids,PPI combination was not superior to conventional antiemetic drugs in the total effective rate of preventing vomiting.However,the effective rate of preventing acute or chronic nausea and vomiting of PPI combined with antiemetic drugs was not superior to that of conventional antiemetic drugs.While there was no significant difference in the incidence of other adverse events between two groups.And the cost-effectiveness analysis of PPI combined with antiemetic drugs and conventional antiemetic drugs in the control of nausea and vomiting showed the incremental cost-effectiveness ratio were 7.82 and 7.48,respectively.Sensitivity analysis showed that the results were stable.CONCLUSION PPI is not recommended for the prevention of high emetic risk chemotherapy induced nausea and vomiting.PPI combined with antiemetic drugs can be considered for large-dose glucocorticoids in antiemetic drugs or combined with high risk factors of stress ulcer,and oral dosage forms should be given as far as possible.

关 键 词：质子泵抑制剂 卫生技术评估 高催吐风险化疗所致恶心呕吐 META分析 成本-效果 

分 类 号：R956[医药卫生—药学]