丹蒌片治疗稳定型冠心病药物经济学研究:一项基于队列研究的结果分析

Pharmacoeconomics Study of Danlou Tablets in the Treatment of Stable Coronary Heart Disease:An Analysis Based on Cohort Study

目的观察评价丹蒌片治疗稳定性心绞痛的经济性,为指导合理用药提供参考。方法选取2015年11月-2017年12月期间,全国47家临床医院接受治疗的2243例稳定性心绞痛患者,其中暴露组1493例,非暴露组750例,非暴露组选择单纯西医常规治疗,暴露组在西医常规治疗基础上加用中成药丹蒌片。采用成本-效果和成本-效用分析方法,对暴露组西医常规治疗基础上加用中成药丹蒌片和非暴露组采用西医常规治疗稳定性心绞痛的经济性进行比较。结果治疗稳定性心绞痛48周的治疗成本:暴露组为(4554.84±4585.24)元,非暴露组为(4531.06±5648.93)元,两队列间比较,差异有统计学意义(P<0.05);暴露组在西医常规治疗基础上加用中成药丹蒌片改善稳定性心绞痛患者生命质量的单位效用成本小于非暴露组西医常规治疗,且丹蒌片治疗多获得一个单位的质量调整生命年需比西医常规治疗多花费33165.74元,低于当前全国人均GDP的3倍。暴露组在西医常规治疗基础上加用丹蒌片治疗稳定性心绞痛,48周内主要心血管事件发生率小于非暴露组西医常规治疗,差异有统计学意义(P<0.05)。西雅图心绞痛量表改善方面,暴露组西医常规治疗基础上加用中成药丹蒌片治疗稳定性心绞痛在改善活动能力、减少心绞痛发作次数、增强治疗满意度、提高疾病认识程度方面优于西医常规治疗,差异有统计学意义(P<0.05)。中医证候改善方面,暴露组总有效率明显高于非暴露组,差异有统计学意义(P<0.05)。暴露组西医常规治疗基础上加用丹蒌片治疗的效用权重系数在1年观察期内由0.8094增加至0.8709,增加0.0615,高于非暴露组西医常规治疗的0.0480(观察期内由0.8064增加至0.8544)。结论西医常规治疗基础上使用丹蒌片相对于西医常规治疗稳定型心绞痛效果占优,经济优势相对明显。

Objective To observe and evaluate the economics of Danlou Tablets in the treatment of treatments for stable angina pectoris(SAP)and to provide references for guiding drug application.Methods From November 2015 to December 2017,2243 patients with SAP treated in 47 clinical hospitals across the country were selected,including 1493 cases in the treatment group and 750 cases in the control group.The control group chose conventional Western medicine treatment alone.The treatment group chose Chinese patent medicine Danlou Tablets on the basis of conventional Western medicine treatment.The cost-effectiveness and cost-utility analysis methods were used to compare the economic efficiency of adding traditional Chinese medicine Danlou tablets to the conventional treatment of western medicine in the treatment group and the conventional treatment of SAP by western medicine in the control group.Results The treatment cost for SAP for 48 weeks:the treatment group(4554.84±4585.24)yuan,the control group(4531.06±5648.93)yuan,the difference between the two cohorts was statistically significant(P<0.05).The treatment group on the basis of conventional Western medicine treatment,the unit utility cost of adding Danlou Tablets to improve the quality of life of patients with SAP is less than that of control group.Western medicine conventional treatment,and Danlou Tablets treatment obtains one more unit of quality-adjusted life year than conventional Western medicine treatment.The cost is 33165.74 yuan,which is less than three times the current national GDP per capita.On the basis of conventional Western medicine treatment in the treatment group,Danlou Tablet was used to treat SCHD.The incidence of major cardiovascular events within 48 weeks was lower than that in the control group(P<0.05).In terms of improvement of Seattle Angina Pectoris Scale,the addition of Chinese patent medicine Danlou Tablet to the treatment of stable angina pectoris on the basis of conventional Western medical treatment in the treatment group improved mobility,reduced the number of angina pectoris episodes,and enhanced treatment satisfaction,improved disease awareness is better than conventional western medicine treatment(P<0.05).In terms of TCM syndrome improvement,the total effective rate of the treatment group was significantly higher than that of the control group(P<0.05).On the basis of the conventional Western medicine treatment of the treatment group,the utility weighting coefficient of Danlou tablets increased from 0.8094 to 0.8709 during the 1-year observation period,increased by 0.0615,which was higher than the conventional Western medicine treatment of 0.0480 for the control group(increased from 0.8064 to 0.8544 during the observation period).Conclusion The use of Danlou Tablets on the basis of conventional Western medicine has a better effect than conventional Western medicine for SAP,and it′s cost saving.