3种中成药联合肝动脉化疗栓塞术治疗原发性肝癌网状Meta分析及经济学评价  

Economic Evaluation of 3 Oral Chinese Patent Medicines Combined with TACE on Primary Liver Cancer

作　　者：梁婉娴 夏如玉 曹世欢 金雪晶 LIANG Wan-Xian;XIA Ru-Yu;CAO Shi-Huan;JIN Xue-Jing(Center for Evidence-Based Chinese Medicine,Beijing University of Chinese Medicine,Beijing 100029,China;International Institute of evidence-based traditional Chinese medicine,Beijing University of Chinese Medicine,Beijing 100029,China)

机构地区：[1]北京中医药大学循证医学中心,北京100029 [2]北京中医药大学国际循证中医药研究院,北京100029

出　　处：《中国药物经济学》2022年第12期23-31,38,共10页China Journal of Pharmaceutical Economics

基　　金：北京市科技新星计划(Z211100002121060)。

摘　　要：目的 比较常用的3种口服中成药(养正消积胶囊、复方斑蝥胶囊、槐耳颗粒)联合肝动脉化疗栓塞术(TACE治疗原发性肝癌(PLC)的有效性和经济性。方法 通过文献检索筛选纳入3种中成药联合TACE治疗PLC患者的临床对照试验研究,进行不同口服中成药联合TACE的网状Meta分析,并构建决策树模型进行成本-效果分析。结果 最终纳入21项研究,共3 044例患者。网状Meta分析结果表明,与TACE治疗相比,复方斑蝥胶囊联合TACE、养正消积胶囊联合TACE能提高PLC患者的客观缓解率(ORR)(RR:1.37,95%CI:1.13~1.65;RR:1.14,95%CI:1.02~1.27);在疗程≤60 d的亚组分析中,养正消积胶囊联合TACE依然优于TACE(RR:1.26,95%CI:1.04~1.53)。与TACE相比,复方斑蝥胶囊联合TACE治疗PLC的完全缓解率(CRR)更高(RR:1.70,95%CI:1.03~2.80),养正消积胶囊联合TACE的卡氏功能状态(KPS)评分改善率更高(RR:1.45,95%CI:1.25~1.68)。3种中成药联合TACE的白细胞减少症发生率均低于TACE治疗(RR:复方斑蝥胶囊0.38,95%CI:0.18~0.79;RR:槐耳颗粒0.46,95%CI:0.24~0.87;RR:养正消积胶囊0.47,95%CI:0.35~0.63)。以ORR为产出的经济学结果显示,当每多达成一例客观缓解的意愿支付值高于24 000元时,复方斑蝥胶囊联合TACE具有经济性的概率最高,其次为养正消积胶囊。基于CRR进行经济性分析,当每多达成一例完全缓解的意愿支付值大于400000元时,复方斑蝥胶囊联合TACE、养正消积胶囊联合TACE、槐耳颗粒联合TACE方案具有经济性的概率分别稳定在23%、19%、0%附近。结论 中成药联合TACE较TACE治疗PLC疗效更优,能有效降低化疗药物导致的白细胞降低发生率;3种中成药中,复方斑蝥胶囊和养正消积胶囊联合TACE治疗PLC具有较好的有效性和经济性。Objective To evaluate effectiveness and cost-effectiveness of oral Chinese patent medicines combined with transarterial chemoembolization(TACE) in treating patients with primary liver cancer(PLC). Methods We searched databases,screened and included randomized controlled clinical trials of oral Chinese patent medicines(Fufang Banmao capsule, Yangzheng Xiaoji capsule and Huai’er granule) combined with TACE for patients with PLC. Based on the included studies, network meta-analysis(NWM) was performed and decision tree models were built for cost-effectiveness analysis. Results Twenty one trials involving 3 044 patients were included. The results of NWM showed that taking TACE as the control, Fufang Banmao capsule and Yangzheng Xiaoji capsule combined with TACE respectively improved the PLC objective response rate(ORR)(RR: 1.37,95%CI:1.13~1.65;RR: 1.14, 95%CI: 1.02~1.27). For trials with a treatment course ≤60 days, Yangzheng Xiaoji capsule combined with TACE significantly improved ORR(RR: 1.26, 95%CI: 1.04~1.53) compared with TACE;while the other two did not show such superiority. Compared with TACE, Fufang Banmao capsule combined with TACE had higher complete response rate(CRR)(RR: 1.70,95%CI: 1.03~2.80) and Yangzheng Xiaoji capsule had a significant higher improvement rate regarding the Karnofsky performance status(KPS) score(RR: 1.45,95%CI: 1.25~1.68). The incidence of leucopenia in patients treated with three Chinese patent medicines combined with TACE was lower than in that treated with TACE alone(RR: Fufang Banmao capsule 0.38,95%CI: 0.18~0.79;RR:Huai’er granule 0.46, 95%CI: 0.24~0.87;RR: Yangzheng Xiaoji capsule 0.47, 95%CI: 0.35~0.63). For ORR, economic evaluation showed that Fufang Banmao capsule combined with TACE had the highest probability to be cost-effective when willingness to pay(WTP) was higher than 24 000 yuan, followed by Yangzheng Xiaoji capsule. Regarding the CRR, when WTP is higher than 400 000 yuan, the probabilities of Fufang Banmao capsule combined with TACE, Yangzheng Xiaoji capsule wi

关 键 词：原发性肝癌 养正消积胶囊 复方斑蝥胶囊 槐耳颗粒 网状Meta分析 决策树模型 成本-效果分析 

分 类 号：R735.7[医药卫生—肿瘤] R956[医药卫生—临床医学]