苯溴马隆或非布司他分别联合依托考昔治疗轻中度肾功能不全痛风患者86例疗效观察及成本-效果分析

Effect and cost-effectiveness analysis of Benzbromarone versus Febuxostat in patients with gout and mild-to-moderate chronic kidney disease

目的比较轻中度肾功能不全的痛风患者使用苯溴马隆或非布司他2种药物方案治疗的近期疗效和经济学效果。方法回顾性分析2016年8月至2018年6月海军军医大学附属长海医院收治的86例痛风合并轻中度肾功能不全患者的病历资料,对苯溴马隆、非布司他分别联用依托考昔治疗痛风进行药物疗效观察及成本-效果分析。结果依托考昔+非布司他组、依托考昔+苯溴马隆组治疗后患者血尿酸(SUA)均较同组治疗前显著降低(P<0.05),血肌酐(Scr)较同组治疗前下降,但差异无统计学意义(P>0.05)。两组间SUA降低总有效率及Scr降低总有效率差异无统计学意义(P>0.05)。两组患者不良反应发生率差异无统计学意义(P>0.05)。依托考昔+非布司他组患者的总成本为2580元,依托考昔+苯溴马隆组患者的总成本为1959元。成本-效果分析显示,在降低SUA方面,依托考昔+非布司他组与依托考昔+苯溴马隆组的C/E分别为27.5、21.9,ΔC/ΔE为144.4;在降低Scr方面,依托考昔+非布司他组与依托考昔+苯溴马隆组C/E分别为177.9、248,ΔC/ΔE为94.1。敏感度分析显示,依托考昔+非布司他组、依托考昔+苯溴马隆组的成本分别调整为2053.85、1894.95元;在降低HUA方面,两组的C/E分别为26.1、21.2,ΔC/ΔE为130;在降低Scr方面,两组的C/E分别为170.2、239.9,ΔC/ΔE为84.7。结论虽然对于降低SUA水平而言,依托考昔+苯溴马隆的成本效果较好,但是考虑到对肾功能的保护作用,依托考昔+非布司他也不失为一个好的选择。

Objective To compare short-term effect and cost-effectiveness of the with those of Febuxostat in patients with gout and mild-to-moderate chronic kidney disease.Methods Through the retrospective analysis of 86 cases of gout and mild-to-moderate chronic kidney disease,their efficiencies were observed and the results were evaluated by pharmacoeconomic cost-effectiveness analysis.Results After treatment,the group of Etoricoxib plus Benzbromarone and the group of Etoricoxib plus Febuxostat had a significant decrease of serum uric acid(SUA)(P<0.05),whereas the serum creatinine(Scr) decreased after treatment in both groups,but the difference was not statistically significant no differences.Total effective rates and incidence rates of adverse effect of the 2 groups were no significant difference.The total cost was 2580 yuan in the group of Etoricoxib plus Febuxostat and 1959 yuan in the group of Etoricoxib plus Benzbromarone.The C/E of the 2 groups were 27.5/21.9 and 177.9/248 and the ΔC/ΔE was 144.4 and 94.1 based on SUA and Scr respectively.The sensitivity analysis showned that the total cost was 2053.85 yuan in the group of Etoricoxib plus Febuxostat and 1894.95 yuan in the group of Etoricoxib plus Benzbromarone.The C/E of the 2 groups were 26.1/21.2 and 170.2/239.9 and the ΔC/ΔE was 130 and 84.7 based on SUA and SCr respectively.Conclusion Adding Benzbromarone in patients with Gout and Mild-tomoderate chronic kidney disease is more efficient in pharmacoeconomic cost-effectiveness analysis which can decrease SUA.However,considering about protective effect on renal function,etoricoxib plus febuxostat is just fine.