两种预防顺铂所致呕吐方案的成本-效果分析

Cost-effectiveness Analysis of Two Preventive Schemes for Cisplatin-induced Vomiting

目的 :探讨两种药物治疗方案对顺铂所致呕吐产生的经济效果。方法 :顺铂化疗患者 3 0例 ,采用自身对照 ,依次给予方案Ⅰ (甲氧氯普胺 +地塞米松 )和方案Ⅱ (格拉司琼 )进行预防呕吐治疗 ,运用药物经济学的成本 效果分析方法进行评价。结果 :方案Ⅰ、Ⅱ预防呕吐的成本分别为 77.97和 2 85 .43元 ;有效率分别为 5 6.67%和 93 .3 3 % ;每获得1个单位效果 ,两种方案所需花费的成本分别为 1.3 8和 3 .0 6元 ;在方案Ⅰ的效果基础上 ,每再获得 1个单位效果 ,方案Ⅱ所花费的成本为 5 .66元。结论 :方案Ⅰ为成本 效果比最低的方案 ,但有效率不高 ,方案Ⅱ有效率有较大提高 ,而增加相同的效果所需成本较低 ,故方案Ⅱ是两种治疗方案中较为合理的方案。

Objective:To probe into the economic effects o f two different therapeutic schemes(metoclopramide+dexamethasone; granisetron) i n the prevention of vomiting induced by cisplatin. Methods:30 patients with pulmonary carcinoma were submit ted to cisplatin (DDP) chemotherapy. For the prevention of possible DDP-induced vomiting, the patients were given each 20mg of metoclopramide I.M. and 5 mg of dexamethasone IV 30 min before DDP administration for 3 consecutive days (scheme Ⅰ) during the first course of cisplatin treatment. The same patients were then given each 3 mg of granisetron administered by IV instillation 30 min prior to cisplatin administration for 3 consecutive days (scheme Ⅱ) during the second co urse of DDP treatment. The patients were asked to contrast the effects of the tw o schemes by themselves. The data were assessed with the pharmacoeconomic cost- effectiveness analysis. Results:The costs of schemes Ⅰ and Ⅱ for the preventio n of vomiting were 77.97 and 285.43 yuan, respectively. The effective rates of s cheme Ⅰ and Ⅱ were 56.67% and 93.33%, respectively. For every increase in 1%of effective rate, scheme Ⅰ and scheme Ⅱ were to spend 1.38 and 3.06 yuan, respe ctively ,as additional costs. The cost of scheme Ⅱ for once more increasing 1% of effective rate on the basis of the effect of scheme Ⅰ was 5.66 yuan. Conclusion:It was shown that scheme Ⅰ had a lower cost -effect ratio. However, its effective rate was not high enough. In contrast, sc heme Ⅱ had a fainly high effective rate, and the cost of scheme Ⅱ needed to in crease identical effect was lower than that of scheme Ⅰ. It is therefore clear that scheme Ⅱ should be the more rational one.