良性前列腺增生症患者药物与微创治疗的经济学和有效性分析

Cost and effectiveness analysis of treatments for benign prostatic hyperplasia

目的比较药物[非那雄胺（保列治）、盐酸坦索罗辛（哈乐）及两者联合治疗]或手术（经尿道2μm激光前列腺切除术、经尿道前列腺切除术）治疗良性前列腺增生症（BPH）的经济有效性。方法从2007年7月至2009年6月，前瞻性的收集上海交通大学附属第一人民医院泌尿中心790例BPH的患者，其中药物组390例门诊患者，随机分为3组，分别口服非那雄胺（保列治）（A组）、盐酸坦索罗辛（哈乐）（B组）及两者联合（C组）治疗；手术组400例住院患者分为经尿道2μm激光前列腺切除术患者140例，经尿道前列腺切除术患者260例。比较各组患者的治疗费用及治疗效果。结果前列腺体积A组服药3个月时缩小[由治疗前（50．0±18．3）ml缩小为（44．5±16．1）ml]，哈乐组治疗前后无变化，联合治疗组服药1个月时缩小[由治疗前（55．4±19．7）ml缩小为（50．3±18．5）ml]，与治疗前比较差异有统计学意义（P〈0．05）3组NFR均与服药1个月时增高，IPSS、QOL评分服药1个月时降低，并与服药3、6个月时进一步降低，差异有统计学意义（P〈0．05）。药物治疗3组6个月治疗时的有效率分别为：84％，89％，89％。手术组比药物组5年的治疗费用低。结论保列治联合哈乐是BPH患者药物治疗的较佳选择，2μm激光前列腺切除术比药物治疗更能降低医疗费用，是一种安全有效的手术方式。

Objective To compare the costs and effectiveness of treatments for benign prostatic hyperplasia （ BPH ）, including pharmaceuticals （ finasteride, tamsulosin, combined therapy ）, transurethral 2 micron laser resection of the prostate and transurethral resection of the prostate （TURP）. Methods Since July 2007 to June 2009, a total of 790 patients with BPH were prospectively collected in this study, including 390 outpatients with pharmaceuticals who were randomly classified into 3 groups of finasteride, tamsulosin and combined therapy, 140 inpatients with transurethral 2 micron laser resection of the prostate and 260 inpatients with TURP. The costs and effectiveness of each group were compared. Results Prostate volume of finasteride group was decreased after three months of medication, of tamsulosin group no change, of combined therapy group was decreased after one month of medication. Maximum flow rate （MFR） of three groups was higher after one month of medication. International prostate symptom score （IPSS） and quality of life （QOL） score were decreased after one month of medication and further decreased 3 months, 6 months after the medicine, the difference was statistically significant. The effective rate of three pharmaceutical groups after 6 months of treatment was 84%, 89% and 89%, respectively. The cost of operative group was lower than 5-year cost of pharmaceutical group. Conclusions Tamsulosin combined with finasteride is the better pharmaceutical option for BPH patients and the transurethral 2 micron laser resection of the prostate, the cost of which is lower than pharmaceuticals, is a safe and effective surgery.