质子泵抑制剂四联疗法治疗幽门螺杆菌阳性十二指肠球部溃疡的药物经济学评价

Pharmacoeconomics evaluation of proton pump inhibitor-based quadruple therapy regimens for duodenal ulcer with Helicobacter pylori infection

目的不同质子泵抑制剂四联疗法治疗幽门螺杆菌(Hp)阳性十二指肠球部溃疡的药物经济学评价。方法将120例Hp阳性十二指肠球部溃疡患者随机均分为四组,分别采用奥美拉唑(A组)、兰索拉唑(B组)、埃索美拉唑(C组)和雷贝拉唑(D组)四联疗法治疗,分析各组Hp根除率、溃疡治疗有效率、不良反应发生率以及CYP2C19基因型,并通过药物经济学评价方法比较各组治疗方案的成本-效果比和增量成本-效果比。结果四组在治疗十二指肠球部溃疡患者中的Hp根除率、溃疡治疗有效率、不良反应发生率以及CYP2C19基因型检测方面均无统计学差异(P>0.05);但A组在Hp根除率及溃疡治疗有效率方面的成本-效果比值最低,方案最经济。结论质子泵抑制剂四联疗法是Hp阳性十二指肠球部溃疡安全、有效的治疗方案;其中,奥美拉唑最为经济,临床可依据患者具体情况选择药物。

Objective To evaluate pharmacoeconomically different proton pump inhibitor-based quadruple therapy regimens for duodenal ulcer with Helicobacter pylori（Hp） infection .Methods A total of 120 duodenal ulcer patients with Hp infection was equally randomized into four groups and treated with a quadruple therapy ,which was omeprazole-based（group A） ,lansoprazole-based（group B） ,esomeprazol-based（group C） and rabeprazole-based（group D） ,respectively .The eradication rate of Hp ,healing rate of ulcer ,adverse effects and genotypes of CYP2C19 were analyzed .The ratio of cost to effectiveness and the ratio of incremental cost to effectiveness were calculated by pharmacoeconomic evaluation .Results There was no significant difference in the eradication rate of Hp ,healing rate of ulcer ,adverse effects and genotypes of CYP2C19 among four groups （ P〉0 .05 ） .But the cost-effectiveness ratios of eradication rate of Hp and healing rate of ulcer were the lowest in group A compared to other groups .Conclusion Proton pump inhibitor-based quadruple therapy is a safe and effective regimen for duodenal ulcer with Hp infection ,of which omeprazole is the most economical . Medication should be selected according to patient-specific clinical cases .