泮托拉唑与雷尼替丁治疗胃食管反流的药物经济学评价

Pharmacoeconomic Evaluation of Pantoprazole and Ranitidine in the Treatment of Gastricesophagitis Reflux Disease

目的：对泮托拉唑与雷尼替丁治疗胃食管反流的药物经济性进行评价。方法：计算机检索Pub Med、EMBase、The Cochrane Library、中国知网、维普和万方数据库,查找口服用泮托拉唑与雷尼替丁治疗胃食管反流的随机对照试验,检索时间从建库至2014年9月。由2位研究员根据纳入与排除标准独立进行文献筛选、资料提取,采用Stata 12.0软件估算疗效指标及成本,并以决策树模型进行成本-效果分析。结果：共纳入7项随机对照试验,患者人数1 389例。成本-效果分析结果提示,治疗Ⅰ~Ⅲ级（按Savary-Miller标准分级）胃食管反流,雷尼替丁的成本-效果比均低于泮托拉唑（Ⅰ级：18.86 vs.57.93;Ⅱ或Ⅲ级：35.58 vs.146.13）,增量成本-效果比Ⅰ级为335.53,Ⅱ或Ⅲ级为349.85;敏感性分析支持该结论。结论：雷尼替丁是治疗Ⅰ~Ⅲ级胃食管反流更为经济的方案,但增量成本-效果比波动范围较大,临床用药可根据患者的病情及经济状况制订个体化方案。

OBJECTIVE： To evaluate the pharmacoeconomics of pantoprazole vs. ranitidine in the treatment of gastricesophagitis reflux disease（GERD）. METHODS： Retrieved from PubMed, EMBase, The Cochrane Library, CNKI, VIP and Wanfang database, RCTs about pantoprazole vs. ranitidine in the treatment of GERD were selected until Sept. 2014. Two reviewers independently screened literature in accordance with the inclusion and exclusion criteria, and extracted the data of included studies. Stata 12.0 software was used to estimate therapeutic efficacy index and cost, and cost-effectiveness analysis was performed with the decision tree model. RESULTS ： A total of 7 RCTs were included, involving 1 389 patients. Cost-effectiveness analysis showed that for grade Ⅰ - Ⅲ （by Savary-Miller standard） GERD, cost-effectiveness ratios of ranitidine were all lower than those of pantoprazole （grade Ⅰ ： 18.86 vs. 57.93;grade Ⅱ or Ⅲ ： 35.58 vs. 146.13）; grade Ⅰ, Ⅱ,Ⅲ incremental cost-effectiveness ratio （ICER） were 335.53,349.85,349.85. Sensitivity analysis supported this conclusion. CONCLUSIONS： Ranitidine is more economic therapy plan for grade Ⅰ -Ⅲ GERD, but its ICER fluctuates greatly. Individual therapy plan should be formulated according to disease condition and economic condition.