国家基本药物中口服降糖药的药物经济学分析

Pharmacoeconomics of the oral antidiabetic drugs in National Essential Medicine

比较国家基本药物中口服降糖药治疗2型糖尿病的经济效果.选取体重指数19～27 kg/m2的2型糖尿病患者200例,分为5组,每组40例,分别给予格列本脲（A组）、格列吡嗪（B组）、二甲双胍（C组）、格列本脲＋二甲双胍（D组）、格列吡嗪＋二甲双胍（E）进行治疗,观察疗效,采用药物经济学中的成本-效果分析法（CEA）进行分析.5组均可有效控制血糖,均可显著降低HbA1c.格列本脲更符合药物经济学原则,但由于易发生严重而持久的低血糖限制其临床广泛应用,老年患者应更加慎重；在以控制空腹血糖和体重为主要目标时选择二甲双胍更经济；在以控制餐后血糖为主要目标时选择格列吡嗪更为合理,尤其是体形偏瘦者更为合适；格列吡嗪＋二甲双胍联合用药方案适合单用格列吡嗪或二甲双胍效果不佳者,值得推荐.

To compare the economic efficacies of the oral antidiabetic drugs in National Essential Medicine for treating type 2 diabetes mellitus.200 diabetic patients with body mass indices between 19-27 kg/m2 were assigned into 5 groups：group A received glibenclamide,group B glipizide,group C metformin,group D glibenclamide ＋metformin,and group E glipizide ＋ metformin.Pharmacoeconomic evaluation was performed by cost-effectiveness analysis（ CEA ）.Fasting glucose level in patients treated with these 5 drugs all decreased significantly,as well as HbA1c.Glibenclamide was more in line with the principles of pharmacoeconomics,but should be used carefully for its serious and prolonged hypoglycemia,especially in elderly patients.According to the method of cost-effectiveness analysis,it was more economical to use metformin to control fasting glucose level while it is more reasonable to use glipizide to control the postprandial glucose whereas controlling of postprandial blood glucose is considered as a priority.Glipizide＋mefformin combination may be recommended to the patients whose blood glucose level is poorly controlled by a single drug alone.