5类抗类风湿性关节炎类药物的成本-效果分析——基于贝叶斯MTC法

Cost-effectiveness analysis of 5 types of anti-rheumatoid arthritis drugs——Based on Bayesian MTC method

目的综合评价中药汤剂、中药复方制剂、中药单体和提取物、非甾体抗炎药及慢作用抗风湿药等5类抗类风湿性关节炎类药物的有效性、安全性和经济性。方法检索并筛选得到相关临床随机对照试验的文献并建立信息数据库,运用Win BUGS1.4.3软件构造随机效应模型,综合评估这5类药物的有效性、安全性及经济性并进行优劣排序。结果以非甾体抗炎药物作为参照,每提高1%的有效率,使用中药汤剂和中药复方制剂分别需增加成本0.95和0.81元,中药单体和提取物和慢作用抗风湿药分别减少成本0.26和0.09元。结论中药单体和提取物及慢作用抗风湿药的增量成本效果比值较小,经济性较高,但其不良反应较多,因此当增量成本效果比在付费方最大支付意愿之内时,单纯成本效果比高的用药方案如中药汤剂类和中药复方制剂类药物是可以被接受的。

Objective To evaluate the effectiveness,safety and economic effect of 5 types of antirheumatoid arthritis drugs,including traditional Chinese medicine（ TCM） decoction,TCM compound preparation,TCM monomer and extract,non-steroidal anti-inflammatory drugs and slow acting antirheumatic drugs. Methods Based on retrieval and screening of the relevant clinical randomized controlled trials,we constructed a random effect model to evaluate these information data by using Win BUGS1. 4. 3software. Results Compared with non-steroidal anti-inflammatory drugs,TCM decoction and TCM compound preparation increased the cost of 0.95 and 0.81 yuan,but TCM monomer and extract and slow acting anti-rheumatic drugs decreased the cost of 0. 26 and 0. 09 yuan when improving the efficiency of1%. Conclusion The incremental cost-effectiveness ratio about TCM monomer and extract and slow acting anti-rheumatic drug is small because of their side-effects. When the incremental cost-effectiveness ratio is within the willingness payment,the simply high cost-effectiveness ratio of therapy such as TCM decoction and TCM compound preparation could be acceptable.