中国10家肿瘤专科医院2013年至2016年应用镇痛治疗药物使用趋势分析

Analysis of analgesics use trend in ten cancer hospitals in China from 2013 to 2016

目的:分析中国2013年至2016年肿瘤专科医院镇痛药物使用情况,并以WHO癌痛三阶梯止痛治疗原则及NCCN指南为依据,分析中国肿瘤患者镇痛药物及辅助镇痛药物的使用现状,为临床合理用药提供参考。方法:采用回顾性分析方法,调取2013~2016年中国10家肿瘤专科医院肿瘤患者使用镇痛药物及辅助镇痛药物的数据,对药品剂型、金额、用药频度(the defined daily doses,DDDs)、日均费用(the defined daily cost,DDC)及药品排序比(the drug sequence ratio,B/A)进行统计分析。结果:在2013~2016年间中国使用镇痛治疗药物的患者占全部肿瘤患者数的12.6%,镇痛药物金额占全部肿瘤患者用药总金额的1.5%。镇痛治疗药物的使用以阿片类药物为主,占镇痛治疗药物金额的90.9%,其他类型镇痛治疗药物如抗惊厥类药物用量有所增加。患者镇痛治疗药物以口服、注射剂和外用给药途径为主,各品种镇痛治疗药物的DDDs排名基本稳定,芬太尼贴剂、艾司唑仑、羟考酮口服剂型、吗啡口服剂型和吲哚美辛栓剂DDDs值位居前列。大部分镇痛治疗药物的DDC值变化不大,反映其价格基本稳定,13种镇痛治疗药物的DDC值位于10~100。各类镇痛治疗药物的B/A值大部分接近1,其中位于0.5~1.5的共17种,占总药物种类的58.6%,表明用药同步性较好。结论:镇痛治疗药物在临床应用日趋增长,中国癌痛治疗基本遵从WHO推行的三阶梯用药原则,但也存在个别药品日均费用较高、同步性较差的问题,需进一步加强管理,癌痛治疗有待进一步规范。

Objective： To analyze the utilization of analgesics in ten cancer hospitals in China from 2013 to 2016; to analyze the use status of analgesics and auxiliary analgesics in Chinese patients with cancer, based on the three-step analgesic ladder principle announced by the WHO and the guidelines of National Comprehensive Cancer Network（NCCN）, and to provide data for the rational use of cancer analgesics in clinical practice. Methods： A retrospective analysis method was used to extract data on the use of analgesics and auxiliary analgesics in ten cancer hospitals in China between 2013 and 2016. Subsequently, statistical analyses were conducted on the dosage form of the drugs, the total consumption, the defined daily doses（DDDs）, the defined daily cost（DDC）, and the drug sequence ratio（B/A）. Results： Between 2013 and 2016, patients using analgesics in China comprised 12.6% of the total number of cancer patients and the cost of analgesics accounted for 1.5% of the total cost of medication for all patients. The main analgesics used were opioids, which accounted for 90.9% of the cost of analgesics; the other types of analgesics, such as the anticonvulsant drugs,were increased. The major administration routes of analgesics in patients were oral, injectable, and topical routes. The DDD rankings of all types of analgesic treatment drugs were basically stable. The DDD values of fentanyl patches, estazolam, oxycodone oral dosage form, morphine oral dosage form, and indomethacin suppository were among the best. The DDC values for most analgesics did not change much, which reflected that price was stable. The DDC values of 13 analgesics were between 10 and 100. Most of the B/A values of all kinds of analgesics were close to 1, with 17 between 0.5 and 1.5, comprised 58.6% of all types of drugs, which indicated that medication synchronization was good. Conclusions： The clinical applications of analgesics are increasing. In China, the treatment of cancer pain generally follows the three-step analgesic ladder principle announced by the WHO. However, there are also some problems. For instance, the daily average cost of a few drugs was high and the synchronization was poor. Therefore, it is necessary to improve the management and regulate the treatment of cancer pain.