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目的比较三种不同的质子泵抑制剂治疗非静脉曲张性上消化道出血的成本-效果。方法将2012年7月至2014年7月南京医科大学附属无锡人民医院收治的90例非静脉曲张性上消化道出血患者按照随机数字表法分为A组、B组、C组,各30例。A组:静脉注射埃索美拉唑40 mg,每日2次,5 d为1个疗程;B组:静脉注射奥美拉唑40 mg,每日2次,5 d为1个疗程;C组:静脉注射兰索拉唑30 mg,每日2次,5 d为1个疗程。比较三组患者止血时间、显效时间及总有效率,并采用成本-效果分析法对3种治疗方案进行评价。结果 A组止血时间[(10.4±2.9)h]、显效时间[(5.7±1.6)h]均显著低于B组[(14.4±4.7)h、(9.5±1.8)h]和C组[(13.6±3.5)h、(8.9±1.7)h],组间比较差异有统计学意义(P<0.05),B组和C组止血时间、显效时间比较差异无统计学意义(P>0.05)。A组总有效率为93.3%(28/30),B组为90.0%(27/30),C组为83.3%(25/30),三组总有效率比较差异无统计学意义(P>0.05)。成本-效果分析显示,A组成本-效果比(C/E)为14.8,B组为11.1,C组为12.8;灵敏度分析显示,A组C/E为13.3,B组为10.0,C组为11.6。结论从药物经济学角度考虑,奥美拉唑治疗非静脉曲张性上消化道出血成本效果比优于埃索美拉唑和兰索拉唑,值得临床推广。
Objective To compare the cost-effectiveness of three different proton pump inhibitors in the treatment of non-variceal upper gastrointestinal bleeding. Methods From July 2012 to July 2014, 90 patients with non-variceal upper gastrointestinal bleeding admitted to Wuxi People’s Hospital Affiliated to Nanjing Medical University were divided into A group, B group and C group according to random number table . Group A: intravenous injection of esomeprazole 40 mg twice daily for 5 days for a course of treatment; Group B: intravenous omeprazole 40 mg twice daily for 5 days for a course of treatment; C Group: Lansoprazole 30 mg intravenously, 2 times a day, 5 days for a course of treatment. Three groups of patients were compared to stop bleeding time, effective time and total effective rate, and cost-effectiveness analysis of three kinds of treatment programs were evaluated. Results The bleeding time in group A was significantly lower than that in group B ([(10.4 ± 2.9) h] and effective time [(5.7 ± 1.6) h] [(14.4 ± 4.7) 13.6 ± 3.5) h and (8.9 ± 1.7) h, respectively. The difference between the two groups was statistically significant (P <0.05). There was no significant difference between the two groups in the bleeding time and the effective time (P> 0.05). The total effective rate was 93.3% (28/30) in group A, 90.0% (27/30) in group B and 83.3% (25/30) in group C. The total effective rate was no significant difference between the three groups (P> 0.05). The cost-effectiveness analysis showed that the cost-effectiveness ratio (C / E) of group A was 14.8, that of group B was 11.1 and that of group C was 12.8. Sensitivity analysis showed that the C / E of group A was 13.3, that of group B was 10.0, 11.6. Conclusion From the perspective of pharmacoeconomics, the cost-effectiveness of omeprazole in the treatment of non-variceal upper gastrointestinal bleeding is superior to esomeprazole and lansoprazole, which is worthy of clinical promotion.