3种治疗方案根除幽门螺杆菌的成本-效果分析

Cost-effectiveness Analysis of 3 Therapeutic Schemes for Helicobacter pylori Eradication

目的:评价3种治疗方案根除幽门螺杆菌的成本与效果。方法:将128例消化性溃疡或慢性胃炎患者随机分为3组。A组41例,给予泮托拉唑(40 mg,bid)+阿莫西林(1 g,bid)+克拉霉素(0.5 g,bid);B组44例,给予泮托拉唑(40 mg,bid)+阿莫西林(1 g,bid)+左氧氟沙星(0.2 g,bid);C组43例,前5日给予泮托拉唑(40 mg,bid)+阿莫西林(1 g,bid),后5日改为泮托拉唑(40 mg,bid)+左氧氟沙星(0.2 g,bid)+克拉霉素(0.5 g,bid)。疗程均为10 d。观察3组的临床疗效,并进行成本-效果分析。结果:B组的按方案治疗(PP)根除率和意向治疗(ITT)根除率与C组比较差异无统计学意义(P>0.05),但与A组比较差异有统计学意义(P<0.05);B组PP根除率和ITT根除率的成本-效果比及增量成本-效果比均优于A组和C组。结论:从药物经济学角度来看,B方案为最经济、有效的治疗幽门螺杆菌方案,可以推广;A方案最差,不应再作为一线治疗方案考虑。

OBJECTIVE：To evaluate the cost and effectiveness of 3 therapeutic schemes for Helicobacter pylori eradication.METHODS：128 patients with peptic ulcer or chronic gastritis were randomly divided into 3 groups. Group A（41 cases）was given pantoprazole（40 mg,bid）＋amoxicillin（1 g,bid）＋clarithromycin（0.5 g,bid）;group B（44 cases）was received pantoprazole（40mg,bid）＋amoxicillin（1 g,bid）＋levofloxacin（0.2 g,bid）;group C（43 cases）was given pantoprazole（40 mg,bid）＋ amoxicillin（1 g,bid）for first 5 days,and then given pantoprazole（40 mg,bid）＋levofloxacin（0.2 g,bid）＋clarithromycin（0.5 g,bid）for next5 days. The treatment course lasted for 10 days. Clinical efficacies of 3 groups were observed,and cost-effectiveness analysis was conducted. RESULTS：There was no statistical significance in the rate of PP and ITT eradication between group B and C（P0.05）,but those of group B were greatly higher than those of group A（P0.05）. Cost-effectiveness ratio and incremental cost-effectiveness ratio of PP and ITT eradication rate in group B were better than in group A and C. CONCLUSIONS：From the perspective of pharmacoeconomics,group B is the most economical and effective one for H. pylori,which is worth promoting;while group A is the worst one.