可利新、思他宁和善宁治疗肝硬化食管静脉曲张破裂出血的费用-效果分析

The Analysis of Cost-Effectiveness of Controlling Esophageal Variceal Bleeding of Glypressin, Somatostatin and Octreotide

为比较可利新、思他宁和善宁对食管静脉曲张破裂出血 (EVB)的止血疗效及费用 /效果比 ,选择确诊为肝硬化 ,经急诊内镜证实为活动性 EVB的患者 16 7例 ,分为 3组 :可利新组 5 0例 ,思他宁组 6 1例和善宁组 5 6例 ,观察 3组对EVB的止血疗效并采用成本效果分析法进行药物经济学分析。发现可利新和思他宁的总止血成功率相似 (90 %与88.5 % ,P>0 .0 5 ) ,但明显优于善宁 (6 7.9% ,P<0 .0 1)。善宁组 1周内再出血率显著高于可利新组及思他宁组 (P<0 .0 5 ) ,而 1周内死亡率及副反应发生率与其他两组无显著差异 (P>0 .0 5 )。3组病例费用 /效果比分别为 6 796 .9元、6 6 98.0元及 76 0 2 .7元 ,可利新组和思他宁组低于善宁组。结果表明可利新和思他宁治疗肝硬化合并急性 EVB的临床疗效及经济学效果相似 ,且明显优于善宁。从疗效及药物经济学双重考虑 ,可利新和思他宁是目前控制 EVB较为理想的血管活性药物 ,可作为治疗

The efficacy and cost effectiveness of glypressin, somatostatin and octreotide in the treatment of esophageal variceal bleeding (EVB) in cirrhotic patients were compared. Of the 167 patients with EVB, 50 received intravenous glypressin (glypressin group), 61 received somatostatin (somatostatin group) and 56 received octreotide (octreotide group). The therapeutic effectiveness of the three groups for EVB was observed and the drug economical analysis was performed by using cost effectiveness analysis method. The results showed that the success of glypressin (90 %) and somatostatin (88 5 %) in controlling EVB was similar, but significantly higher than octreotide (67 9 %, P <0 01), but there was no significant difference in one week rebleeding rate ( P <0 05), but there was no significant difference in one week mortality and the incidence of side effects among the three groups ( P >0 05). The ratio of cost effectiveness in the glypressin group and somatostatin group was 6796 9 yuan RMB and 6698 0 yuan RMB respectively, less than that in the octreotide group (7602 7 yuan RMB). The results demonstrated that the efficacy and economic efficiency of glypressin and somatostatin in controlling EVB had no difference, but superior to those of octreotide. It suggests that glypressin and somatostatin are highly effective as first line treatment of EVB in cirrhotic patients.