老年糖尿病不同类型胰岛素治疗方案的药物经济学评价

Pharmacoeconomic evaluation on various insulin-based therapeutic regimens for elderly patients with diabetes

目的:运用药物经济学中的成本效果分析方法评价不同类型胰岛素治疗老年糖尿病的短期药物经济学效果,以便为老年糖尿病患者选择胰岛素治疗提供依据。方法:选择167例患者,采用回顾性对照研究,从患者角度出发,以血糖值作为效果衡量指标,运用成本效果分析方法评价胰岛素3种给药方案(A组:短效动物胰岛素+中效动物胰岛素;B组:诺和灵R+诺和灵N;C组:诺和锐+来得时)治疗老年糖尿病的药物经济学效果,并进行敏感性分析。结果:3种方案的有效率分别为80.8%、94.7%和98.2%,C方案疗效优于B方案,B方案疗效优于A方案。A、B和C方案治疗总成本分别为184.29元、571.32元和1312.33元;使平均血糖下降1个百分点,费用分别为5.65元、14.52元和27.36元。敏感度分析显示经济学分析结果稳定。结论:3种治疗方案都能将血糖控制在理想范围,从药物经济学的角度分析,诺和灵R+诺和灵N方案为佳;诺和锐+来得时方案疗效最好,但成本效果比最高。

Objective： To evaluate the short-term pharmacoeconomic efficacy of various insulin-based therapeutic regimens for diabetes care in elderly patients using cost-effectiveness analysis in order to provide the evidence for selecting insulin therapy for the elderly patients. Methods： A retrospective study was performed on the clinical data of 167 patients. From the interest of the patients, the brood glucose level was used as an index for evaluating therapeutic efficacy. Cost-effectiveness analysis was performed to estimate the pharmacoeconomic efficacy of three types of insulin therapeutic regimens （Group A ： short-term animal insulin＋isophane insulin ; Group B ： Novolin R＋Novolin N ; Group C ： Novo Rapid＋Lantus） in elderly patients. The sensitivity of the patients to the therapeutic regimen was also analyzed. Results： The effective rate was 80.8%, 94.7% and 98.2% for Group A, Group B and Group C respectively. The type C regimen was superior than type B regimen and type B regimen was superior than type A regimen. The whole cost of the A, B, C regimen was 184.29 RMB, 571.32 RMB and 1 312.33 RMB respectively. It respectively costed 5.65 RMB, 14.52 RMB and 27.36 RMB to make the mean blood glucose level to decrease one percent. Sensitivity analysis showed that the pharmacoeconomic analysis results were stable. Conclusion： The three therapeutic regimens controlled the blood glucose level in the normal range. In the view of pharmacoeconomics, type B regimen （Novolin R＋Novolin N） is better. The short-term efficacy of Novo Rapid＋Lantus is the best, but the ratio of the cost to efficacy is the highest.