四种阿片类镇痛药用于癌性疼痛治疗的药物经济学评价

Pharmacoeconomic analysis of four opioid analgesics in treatment of cancer pain

目的:探讨盐酸吗啡缓释片(美菲康)、硫酸吗啡缓释片(美施康定)、盐酸羟考酮控释片(奥施康定)、芬太尼透皮贴剂(多瑞吉)用于癌性疼痛患者镇痛治疗的成本效果,为临床合理用药提供指导。方法:随机调查2011年2月至2012年4月我院240例分别使用美菲康(58例)、美施康定(60例)、奥施康定(62例)和多瑞吉(60例)治疗晚期癌痛的住院患者。美菲康给药初始剂量为30mg,q12h,美施康定给药初始剂量为30mg,q12h,奥施康定给药初始剂量为10mg,q12h,多瑞吉外用贴于皮肤,起始剂量4.2mg,q72h,治疗中出现暴发痛者给予硫酸吗啡即释片,根据疼痛缓解情况决定剂量的调整直至将疼痛缓解至病人满意的程度即VAS 0-3分。不良反应给予对症处理。比较用药一个月后的镇痛疗效、不良反应及用药成本,运用药物经济学成本-效果分析法评价四组治疗方案。结果:美菲康、美施康定、奥施康定和多瑞吉的疼痛缓解率分别为91.38%、91.67%、93.55%、93.33%,四组无显著性差异(P>0.05)。人均成本分别为1279.26元、1346.53元、1507.66元、2018.12元,成本-效果比分别为13.40、14.68、16.12、21.62。结论:美菲康、美施康定、奥施康定和多瑞吉用于晚期癌痛患者镇痛疗效相当,从药物经济学角度来看,美菲康是癌痛患者镇痛治疗的较佳选择。

Objective：To investigate the cost - effectiveness of morphine hydrochloride sustained - release tablets, morphine sulfates sustained - release tablets （ MS contin）, oxycodone hydrochloride controlled - release tablets （ Oxy- contin） and transdermal fentanyl（Duragesic） in treatment of cancer pain. Methods： All 180 cases of advanced cancer pain patients were treated with morphine hydrocbloride sustained -release tablets （58 cases） , MS contin （60 cases ） , Oxycontin （62 cases ） and Duragesic （60 eases）. Initial dose of morphine hydrochloride sustained - release tablets was 30mg ql2h, initial dose of MS contin was 30mg ql2b, initial dose of Oxycontin 10mg ql2h,initial dose of Duragesic 4.2mg q72h. Patients with outbreak pain were treated with morphine temporarily, dose was adjusted ac- cording to score VAS 0 - 3 of easement of pain. The ADRs were deal with symptomatic treatment. The therapeutic effect, drug cost and adverse reaction were evaluated by cost effectiveness analysis one month after treatment. Re- stilts： Pain relief rate of morphine bydrochloride sustained - release tablets, MS contin, Oxycontin and Duragesic were 91.38% , 91.67% , 93.55% , 93.33% , respectively and there were no significant difference between four groups. The cost and cost - effectiveness rate of four groups were 1279.26 yuan, 1346.53 yuan, 1507.66 yuan, 2018.12 yuan, 13.40, 14.68, 16.12, 21.62, respectively. Conclusion： There were no statistic differences of an- algesic effect between four groups. The morphine hydrochloride sustained - release tablets was the better schedule in treatment of cancer pain from pharmacoeconomics.