十二指肠球部溃疡治疗的费用效果分析

A cost_effectiveness study on treatment of duodenal ulcer

目的比较两种治疗方案（ＯＡ：奥美拉唑＋阿莫西林；ＡＭＴ：阿莫西林＋甲硝唑加泰胃美）愈合十二指肠球部溃疡，根除幽门螺杆菌（Ｈｐ）感染，减少溃疡复发的效率（即费用＿效果）．方法１９９５年采用随机对照临床试验ＯＡ组４６例，ＡＭＴ组４３例，作为分析模型，以上海市三级甲等医院的收费为标准，进行费用＿效果分析．结果ＡＭＴ方案平均每愈合１例溃疡的费用为５４６２５元，较ＯＡ方案节约７５０５１元；每根除１例Ｈｐ感染的费用为７０２３２元，较ＯＡ方案节约１０４０２１元；ＡＭＴ＋三联治疗平均每减少１例溃疡复发的费用为６４０３９元，较ＯＡ＋三联治疗节约７８４１５元．在全部费用中直接医疗费用占绝大部分，且其中主要是首次治疗药品费用．ＯＡ方案与ＡＭＴ方案的费用差别主要由首次治疗的药品费用引起．直接非医疗费用及间接费用在二种方案之间无明显差别．结论同时考虑临床疗效及医疗费用，ＡＭＴ治疗较ＯＡ治疗有更好的费用＿效果，尤其对单发，直径在１ｃｍ及以下的十二指肠球部溃疡优于ＯＡ方案治疗，值得临床推广应用．

AIM\ To assess the efficiency of therapy of 2_week amoxicillin plus metronidazole with 6_week tagamet (AMT group) and therapy of 6_week omeprazole plus 2_week amoxicillin (OA group) for ulcer healing, Helicobacter pylori (Hp) eradication and ulcer recurrence decreasing in duodenal ulcer. METHODS\ Cost_effective analysis based on a randomized controlled trial in 1995 in patients with duodenal ulcer (OA group, 46 patients; AMT group, 43 patients) in ⅢA grade hospitals in Shanghai. RESULTS\ The costs of the AMT group were less than those OA group for ulcer healing ($546 25 vs $1296 76 per case, P <0 01), Hp eradication ($702 32 vs $1742 53 per case, P <0 01) and ulcer recurrence decreasing ($640 39 vs 1424 54 per case, P <0 01). The major cost in the treatment of duodenal ulcer was direct cost. The difference of the cost between two groups was mainly caused by the cost of the different drugs. There was no significant difference between two groups in direct non_medical cost and indirect cost. CONCLUSION\ Considering the effectiveness and the costs, the AMT therapy was more efficient than the OA therapy. The AMT therapy would be recommended for its low cost, acceptable healing rates for the ulcer and effective cure of Hp infection, especially in patients with ulcer size below 1cm in diameter.