参苓白术散汤剂与单味颗粒剂提高脾阴虚型厌食症患者机体素质的成本-效果分析

Cost-effectiveness analysis of Shenling baishu san decoction and granule in improving organic diathesis in patients with anorexia of spleen yin deficiency type

目的:探讨价格较高的单味颗粒剂成本-效果的合理性,比较汤剂与单味颗粒剂的参苓白术散治疗脾阴虚型厌食症成本与效益的差异。方法:选择2001-03/2004-11遵义医学院附属医院中医科和各科请中医科会诊的住院脾阴虚型厌食症患者41例,均知情同意。分为2组,汤剂组22例服用参苓白术散的汤剂,颗粒剂组19例服用参苓白术散的单味颗粒剂。应用药物经济学的成本-效果分析方法,对两组患者的临床疗效及住院总成本进行回顾性评价。疗效评价:有效为食欲好转,食量增加;无效为食欲未见改善。住院总成本=药品成本+住院成本+护理成本+误工费。结果:41患者全部进入结果分析。①治疗有效率:参苓白术散单味颗粒剂与汤剂治疗脾阴虚型厌食症基本相似[89.50%,90.90%,(P>0.05)]。②药品成本比较:汤剂组低于颗粒剂组[(汤剂组22例,平均治疗12.9d,每日药价9.80元,药品成本总价126.42元),(颗粒剂组19例,平均治疗10.1d,每日药价18.30元,药品成本总价184.83元)]。③住院成本比较:汤剂组高于颗粒剂组(283.8,222.2元)。④护理成本比较:汤剂组高于颗粒剂组(116.1,60.6元)。⑤误工费比较:汤剂组高于颗粒剂组(299.41,234.42元)。⑥住院总成本比较:颗粒剂组较汤剂组低(702.05,825.73元)。结论:在治疗效果基本接近的情况下,单味颗粒剂的药品价格是汤剂的2倍,但颗粒剂组总成本却较汤剂组低,其原因是单味颗粒剂有效成分提取后药物利用率较高,服药时间短,而使颗粒剂组药物成本的经济效果优于中药汤剂组,符合治疗结果接近时成本小者为最佳治疗方案的理论。

AIM: To compare the differences of the cost and effectiveness between the decoction and granule of Shenling baishu san in treating anorexia of spleen yin deficiency type, and investigate the cost-effectiveness rationality of its granule, which is more expensive. METHODS: Forty-one patients with anorexia of spleen yin deficiency type, who were treated or hospitalized in the Department of Traditional Chinese Medicine, Affiliated Hospital of Zunyi Medical College between March 2001 and November 2004, were treated with the decoction (n=22, decoction group) and granule (n=19, granule group) of Shenling baishu san respectively. The clinical effect and total cost of hospitalization in both groups were retrospectively assessed by means of pharmacoeconomical cost-effectiveness analysis. Assessment of effect: improved appetite and increased appetite as effective; no improved appetite as invalid. Total cost of hospitalization= medication cost + hospitalization cost + nursing cost + delay compensation. RESULTS: All the 41 patients were involved in the analysis of results. ① Effective rate of treatment: The decoction and granule of Shenling baishu san were similar in treating anorexia of spleen yin deficiency type (89.50%, 90.90%, P > 0.05). ② Comparison of medication cost: It was lower in the decoction group (n=22, average length of stay was 12.9 days, daily medication cost was 9.8 yuan, total medication cost was 126.42 yuan) than in the granule group (n=19, average length of stay was 10.1 days, daily medication cost was 18.3 yuan, total medication cost was 184.83 yuan). ③ Comparison of hospitalization cost: It was higher in the decoction group than in the granule group (283.8, 222.2 yuan). ④ Comparison of nursing cost: It was higher in the decoction group than in the granule group (116.1, 60.6 yuan). ⑤ Comparison of delay compensation: It was higher in the decoction group than in the granule group (299.41, 234.42 yuan). ⑥ Comparison of the total cost of hospitalization: It was lower in the granule group than in the decoction group (702.05, 825.73 yuan). CONCLUSION: Under the similar therapeutic effect, the price of granule is twice of decoction, but the total cost is lower in the granule group than in the decoction group; The reason may be that the drug utilization rate of granule is higher after the extract of effective components, so the economic effectiveness of drug cost in the granule group is superior to that in the decoction group. It is in accordance with the theory that when therapeutic effect is close, the therapeutic program with less cost is the best one.