DRG付费下乳腺癌患者化疗致骨髓抑制及肝损伤治疗方案药物经济学评价  

Pharmacoeconomic evaluation of treatment regimens for myelosuppression and liver injury caused by che-motherapy in breast cancer patients under DRG system

作　　者：周天琦 吴楠[1] 白兆石 赵敏[1] 张倩[3] 季花[3] 徐思露 魏继福 ZHOU Ttianqi;WU Nan;BAI Zhaoshi;ZHAO Min;ZHANG Qian;JI Hua;XU Silu;WEI Jifu(Department of Pharmacy,Jiangsu Cancer Hospital&.Jiangsu Institute of Cancer Research&.Affliated Cancer Hospital,Nanjing Medical University,Jiangsu Nanjing 210009,China;China Pharmaceutical University,Jiangsu Nanjing 211198,China;Department of Finance,Jiangsu Cancer Hospital&Jiangsu Institute of Cancer Research&.Affiliated Cancer Hospital,Nanjing Medical University,Jiangsu Nanjing 210009,China)

机构地区：[1]江苏省肿瘤医院,江苏省肿瘤防治研究所,南京医科大学附属肿瘤医院药学部,江苏南京210009 [2]中国药科大学基础医学与临床药学学院,江苏南京211198 [3]江苏省肿瘤医院,江苏省肿瘤防治研究所,南京医科大学附属肿瘤医院财务处,江苏南京210009

出　　处：《中国医院药学杂志》2024年第22期2633-2639,共7页Chinese Journal of Hospital Pharmacy

基　　金：江苏省药学会-奥赛康医院药学科研基金(编号:A202202);江苏省肿瘤医院科技发展基金项目(编号:ZG202203,ZG202102)。

摘　　要：目的:评估乳腺癌患者紫杉醇类药物治疗所致常见并发症不同治疗方案的成本效果,为疾疾诊断相关分组(diagonosis related groups,DRG)支付背景下药物精细化管理提供参考。方法:根据临床试验数据,采用决策树模型及成本-效果分析,评价肝损伤和骨髓抑制治疗方案的优劣,并进行敏感性分析。结果:针对药物性肝损伤的治疗,异甘草酸镁注射液、双环醇片、多烯磷脂酰胆碱注射液的成本-效果比值分别为4 211.49、5 536.28、4 494.16,多烯磷脂酰胆碱的有效率最高(90.74%),较异甘草酸镁的增量成本-效果比(incremental cost-effectiveness ratio,ICER)为5 978;针对白细胞计数降低的预防,聚乙二醇化重组人粒细胞刺激因子和人粒细胞刺激因子的有效率相近,后者成本较低;针对血小板计数降低的治疗,重组人血小板生成素注射液(rhTPO)较注射用白细胞介素-11(rhIL-11)的ICER为24 117.7。敏感性分析支持上述结果的可靠性。结论:多烯磷脂酰胆碱为治疗紫杉醇致肝损伤安全、有效、经济的药物,但双环醇降低转氨酶具有成本-效果优势;人粒细胞刺激因子预防白细胞计数降低经济性稍优于聚乙二醇化重组人粒细胞刺激因子,但后者更为便捷,患者依从性佳;rhIL-11治疗血小板计数降低的经济性更优,但rhTPO的ICER小于人均GDP(85 698元),为治疗紫杉醇类药物相关性血小板降低优选药物。DRG付费背景下优先考虑使用多烯磷脂酰胆碱、人粒细胞刺激因子、rhTPO等具有经济学优势的药物,以较少的资源消耗获得较好的治疗效果,有利于提高医疗服务效率,控制医疗费用支出,推动DRG高效实施。OBJECTIVE To assess the costs and efficacy of therapeutic drugs for common complications caused by taxanes based upon DRG health insurance policy from a hospital perspective and provide references for refined drug management.METHODS According to the clinical trial data,decision tree model and cost-effect analysis were utilized for evaluating the advantages and disadvantages of treatment regimens of liver injury and myelosuppression.Also the sensitivity of results was exam-ined.RESULTS Fordrug-induced liver injury,cost-effectiveness ratio of magnesium isoglycyrrhizinate injection,bicyclol tab-lets and polyene phosphatidylcholine injection was 4211.49,5536.28 and 4494.16 respectively.Polyene phosphatidylcholine achieved the highest effectiveness(90.74%)with an incremental cost-effectiveness ratio(ICER)of 5978 as compared with mag-nesium isoglycyrrhizinate.Pegylated recombinant human granulocyte-stimulating factor and human granulocyte-stimulating factor yielded similar efficiencies and the cost of the latter was lower.For thrombocytopenia,ICER of recombinant human thrombopoi-etin injection(rhTPO)was 24117.7 as compared with interleukin-11 for injection(rhIL-11).Sensitivity analysis confirmed the reliability of the above results.CONCLUSION Polyene phosphatidylcholine injection is safe,effective and economical for treat-ing paclitaxel-induced liver injury.However,bicyclol tablets offers the advantage of reducing transaminases.The economy of human granulocyte colony-stimulating factor injection in preventing leukocytes reduction is slightly better than that of pegylated recombinant human granulocyte colony-stimulating factor injection.However,the latter is more convenient with decent patient compliance.And rhIL-11 is more economical for the treatment of thrombocytopenia.ICER of rhTPO was lower than per capita GDP(¥85698),making it a preferred agent for paclitaxel-associated thrombocytopenia.In the context of DRG payment,prior-ity should be offered to polyene phosphatidylcholine,human granulocyte stimulating factor an

关 键 词：疾病诊断相关分组 药物经济学 紫杉醇类 不良反应 乳腺癌 

分 类 号：R979.1[医药卫生—药品]