鼻渊通窍颗粒联合曲安奈德鼻喷雾剂治疗慢性鼻-鼻窦炎患者的成本-效果分析  

Cost-effectiveness analysis of Biyuan Tongqiao Granules combined with Triamcinolone Acetonide Nasal Spray in treatment of chronic rhinosinusitis

作　　者：黄志艳 张旭升[2] 巩文桥 刘娟 陆丽娟 HUANG Zhi-yan;ZHANG Xu-sheng;GONG Wen-qiao;LIU Juan;LU Li-juan(State Key Laboratory of Generic Manufacture Technology of Traditional Chinese Medicine,Linyi 276006,China;Children's Hospital of Soochow University,Suzhou 215200,China)

机构地区：[1]中药制药共性技术国家重点实验室,山东临沂276006 [2]苏州大学附属儿童医院,江苏苏州215200

出　　处：《中国中药杂志》2023年第15期4237-4242,共6页China Journal of Chinese Materia Medica

基　　金：国家重点研发计划项目(2019YFC1711205)。

摘　　要：该研究旨在评价鼻渊通窍颗粒联合曲安奈德鼻喷雾剂治疗慢性鼻-鼻窦炎(chronic rhinosinusitis,CRS)患者的安全性和经济性。检索EMbase、PubMed、Cochrane Library、中国知网(CNKI)、万方(Wanfang)、维普(VIP)、中国生物医学文献服务系统(SinoMed)鼻渊通窍颗粒联合曲安奈德鼻喷雾剂治疗CRS的随机对照试验(randomized controlled trial,RCT)。采用单组率、Meta分析研究试验组(鼻渊通窍颗粒联合曲安奈德鼻喷雾剂)与对照组(曲安奈德鼻喷雾剂)治疗CRS患者的有效率和鼻纤毛传输时间,采用成本-效果分析从支付方角度进行经济性和敏感性分析。共纳入9篇RCTs,样本量1145例。Meta分析显示,与对照组比较,试验组治疗CRS患者总有效率提高(RR=1.17,95%CI[1.11,1.24],P<0.00001),鼻纤毛传输时间减少(MD=-3.32,95%CI[-5.86,-0.78],P=0.01),差异均有统计学意义;但2组间不良反应发生率差异无统计学意义。增量成本-效果分析显示,对照组与试验组治疗成本分别为44.15、1044.96元,试验组治疗CRS有效率每提高1%需花费75.48元。单因素敏感性分析显示,试验组用药疗程、相对危险度(RR)、鼻渊通窍颗粒单位制剂价格、曲安奈德鼻喷雾剂单组有效率对增量成本-效果比(ICER)影响较大。鼻渊通窍颗粒联合曲安奈德鼻喷雾剂治疗CRS疗效提高,概率敏感性分析显示,当支付意愿大于7920元时[小于2021年0.1倍人均国内生产总值(GDP)8098元],试验组相比于对照组更具有经济性的优势策略。该研究受限于发表的文献量,需开展真实世界鼻渊通窍颗粒联合曲安奈德鼻喷雾剂治疗CRS的临床试验,进一步比较鼻渊通窍颗粒与曲安奈德鼻喷雾剂的成本-效果。This study aims to evaluate the effectiveness and economic efficiency of Biyuan Tongqiao Granules combined with Triamcinolone Acetonide Nasal Spray in the treatment of chronic rhinosinusitis(CRS).The randomized controlled trial(RCT)of Biyuan Tongqiao Granules combined with Triamcinolone Acetonide Nasal Spray in the treatment of CRS was searched against EMbase,PubMed,Cochrane Library,CNKI,VIP,SinoMed,and Wanfang.The efficacy,nasal mucociliary transport time,and safety of the therapy above in the treatment of CRS were analyzed with single-group rate and Meta-analysis,and the economy and sensitivity were evaluated from the perspective of payer.A total of 9 RCTs were included,including 1145 patients.Meta-analysis showed that compared with Triamcinolone Acetonide Nasal Spray alone,Biyuan Tongqiao Granules combined with Triamcinolone Acetonide Nasal Spray in the treatment of CRS patients increased the effective rate(RR=1.17,95%CI[1.11,1.24],P<0.00001)and shortened the nasal mucociliary transport time(MD=-3.32,95%CI[-5.86,-0.78],P=0.01),there was no significant difference in the incidence of adverse reactions between the two groups.The incremental cost-effectiveness analysis showed that the treatment costs of the control group and the observation group were 44.15 yuan and 1044.96 yuan,respectively.In the Biyuan Tongqiao Granules combined with Triamcinolone Acetonide Nasal Spray treatment group,75.48 yuan was spent to improve the effective rate of CRS by 1%.The one-way sensitivity analysis indicated the days of treatment,the RR of Biyuan Tongqiao Granules combined with Triamcinolone Acetonide Nasal Spray,the price of unit preparation of Biyuan Tongqiao Granules,and the effective rate of Triamcinolone Acetonide Nasal Spray alone had great influence on the incremental cost-effectiveness ratio.In conclusion,Biyuan Tongqiao Granules combined with Triamcinolone Acetonide Nasal Spray improves the therapeutic effect on CRS.The probabilistic sensitivity analysis showed that when the willingness to pay was greater than 7920 yuan(

关 键 词：慢性鼻-鼻窦炎 鼻渊通窍颗粒 曲安奈德鼻喷雾剂 META分析 成本-效果 

分 类 号：R765.41[医药卫生—耳鼻咽喉科] R956[医药卫生—临床医学]