慢性乙肝5种治疗方案的临床疗效及成本效果分析

Efficacy and Cost Effectiveness Analysis of Five Different Therapeutic Schemes for Chronic Hepatitis B

目的 探讨治疗慢性乙肝的 5种方案的临床疗效及所产生的经济效果。方法 运用药物经济学的成本—效果分析对慢性乙肝的 5种治疗方案 (A组 :α1b干扰素 ;B组 :拉米夫定 ;C组 :上两种药联合使用 ;D组 :α1b干扰素联合胸腺五肽 ;E组 :胸腺因子α1)进行分析评价。结果 HbeAg阴转率方面 ,B组即拉米夫定组最低 ,仅为 10 94 % ,而其他 4个组均超过 5 0 % ;在HBVDNA阴转率方面 ,拉米夫定组和α1b干扰素联合拉米夫定组最高 ,分别为 85 94 %和 87 93% ;在ALT复常方面 ,C、D、E三组复常率明显高于A、B两组 ,统计学上有显著性差异。从成本效果比看在获得相同效果时所花费的成本中α1b干扰素组、拉米夫定组和α1b干扰素联合拉米夫定组较其他 2组明显降低 ,其中α1b干扰素组 815 6 7元 ;拉米夫定组 6 935元 ;α1b干扰素联合拉米夫定组 15 0 91 7元 ;α1b干扰素联合胸腺五肽组 2 6 0 33 4元 ;α1b干扰素联合胸腺因子α1组 89978 4元。结论 在慢性乙肝病人的药物选择上应首先考虑以单用α1b干扰素、单用拉米夫定或α1b干扰素联合拉米夫定为最佳治疗方案 ,而这 3组当中α1b干扰素联合拉米夫定略好于另外 2组。在经济条件允许、上述治疗效果确实不佳者可考虑联合使用胸腺五肽及胸腺因子α1免疫调节药。

Objective To observe the clinical efficacy and the economic effectiveness of different therapeutic schemes for Chronic hepatitis UB.Methods Patients with Chronic Hepatitis B were treated by using different drugs:Interferon α1b(group A),Lamivudine(group B),Interferon α1b combination with Lamivudine(group C),Interferon α1b combination with thymotentin(group D),Interferon α1b combination with thymosin alphal(group E).Evaluation was carried out with pharmacoeconomic cost-effectiveness.Results At the end of therapy,the clearance rate of serum HbeAg was lowest in group B(10 94%),the other groups were more than 50%.The clearance rate of serum HBV-DNA was higher in group B and C than in the other groups,it was 85 94%,87 93% respectively.Normalizing ALT values was higher in group C,group D and group E than in group A and group B.The costs of several therapeutic schemes were RMB 8156 7(group A),6935(group B),15091 7(group C),26033 4(group D) and 89978 4(group E) yuans,respectively.Conclusions According to the evaluation with pharmacoeconomic cost-effectiveness analysis,the therapeutic scheme of Interferon α1b,Lamivudine and Interferon α1b combination with Lamivudine is best one for treating chronic hepatitsi B,in this groups,Interferon α1b combination with Lamivudine was better than the other two groups.