铋剂四联与序贯疗法根除幽门螺杆菌的药物经济学评价

The pharmacoeconomic evaluation of bismuth quadruple therapy and sequential therapy for Helicobacter pylori eradication

目的比较不同抗生素组合的铋剂四联、序贯疗法根除Hp的成本-效果,确定最佳根除方案。方法选择2014年9月~2015年2月就诊于山西医科大学第一医院消化科门诊初次检测Hp阳性的慢性胃炎患者120例,随机分为三组:A组加例,给予含克拉霉素的铋剂四联方案;B组40例,给予含呋喃唑酮的铋剂四联方案;C组40例,给予序贯疗法。疗程均10 d,停药1个月后复查^(14)C呼气试验。根除率按意向性(Intention To Treat,ITT)分析和符合方案(Per Protocol,PP)分析,计算各方案所需成本并进行成本-效果分析。结果①按ITT分析,A、B、C三组根除率分别为82.5%、87.5%、92.5%;按PP分析,根除率分别为84.6%、89.7%、92.5%,不同方案根除率比较差异无统计学意义(P>0.05)。②3种方案药物成本分别为409.8元、336.2元、322.6元,成本-效果比(C/E)分别为4.84、3.75、3.49。结论序贯疗法根除率最高、成本最低、C/E最小,经济、安全、有效,可作为首选一线根除方案;其次为含呋喃唑酮的铋剂四联方案。

Objective To determine the best regimes through comparing the cost-effectiveness of different antibiotic combinations of bismuth quadruple therapies and sequential therapy for Helicobacter pylori eradication. Methods From September 2014 to February 2015, 120 patients who visited the First Affiliated Hospital of Shanxi Medical University gastroenterology outpatient and initial detection of Hp-positive chronic gastritis were randomly divided into three groups, Group A： 40 patients received clarithromycin-containing Bismuth quadruple therapy; Group B： 40 patients re- ceived furazolidone-containing Bismuth quadruple therapy; Group C： 40 patients received sequential therapy. All regimes for 10 days and reviewed 14C breath test after stop drugs 1 months. Eradication rates by intention to treat （ITT） and per protocol （PP） were evaluated, the cost and evulate the cost-effectiveness of different therapies were calculated. Results （1） By ITT analysis, the eradication rates of three regimens were 82.5%, 87.5%, 92.5% respectively; by PP analy- sis, the eradication rates of three regimens were 84.6%, 89.7%, 92.5% respectively, the difference of eradication rates were not statistically significant（P〉0.05）. （2） The cost of three programs were 409.8 yuan, 336.2 yuan, 322.6 yuan re- spectively, and the cost/effectiveness ratio （C/E） were 4.84, 3.75, 3.49. Conclusion Sequential therapy has highest eradication rate, lowest cost and the minimum of C/E, has the advantage of economic, and safe, effective, can be used as first line therapy. Next is the furazolidone-containing quadruple therapy.