脑苷肌肽注射液治疗急性脑梗死的循证药物经济学评价

Evidence-based pharmacoeconomic evaluation of cattle encephalon glycoside and ignotin injection on acute cerebral infarction

目的从医疗保健系统角度,评估使用脑苷肌肽注射液治疗急性脑梗死的经济性。方法计算机检索中国期刊全文数据库(CNKI)、中文期刊全文数据库(VIP)和万方数据知识服务平台,收集在常规治疗基础上使用脑苷肌肽注射液或丁苯酞氯化钠注射液治疗急性脑梗死的随机对照试验,使用R及JAGS软件通过间接比较的Meta分析对脑苷肌肽注射液(试验组)和丁苯酞氯化钠注射液(对照组)的临床效果进行比较,根据Meta分析的结果选择成本-效果分析法或最小成本分析法,比较两者的经济性。结果本研究共纳入15篇文献,共计1499名患者。间接比较的Meta分析结果显示,试验组与对照组治疗急性脑梗死的有效率差异无统计学意义[OR=0.82,95%CI(0.38,1.90)],最小成本分析结果显示,脑苷肌肽10 mg·d^(-1)、脑苷肌肽20 mg·d^(-1)与丁苯酞治疗费用分别为4333.42元、8562.12元和8118.32元,与丁苯酞相比,脑苷肌肽10 mg·d^(-1)具有经济性,脑苷肌肽20 mg·d^(-1)不具有经济性。结论对于急性脑梗死,相比与丁苯酞氯化钠注射液,常规治疗基础上使用脑苷肌肽注射液最大剂量时不具有经济性,其他剂量均具有经济性,但仍需大样本、高质量研究对其临床效果进行进一步验证。

Objective To evaluate the economics of cattle encephalon glycoside and ignotin injection on acute cerebral infarction from health care payer perspective. Methods Randomized controlled trials （RCTs） were collected by searching CNKI, VIP and WanFang database. Network Meta-analysis was conduct to compare the clinical effect of cattle encephalon glycoside and ignotin injection and butylphthalide and sodium chloride injection on acute cerebral infarction with R and JAGS. Cost-effectiveness analysis or cost-minimization analysis was used for economic evaluation. Results Totally 15 eligible RCTs enrolling 1499 participants were included. Network meta-analysis revealed no significant in clinical effect difference between cattle encephalon glycoside and ignotin injection and butylphthalide and sodium chloride injection [OR = 0.82, 95%CI （0.38, 1.90）]. The cost-minimization analysis showed that the cost of two strategies after 14 days were as follows： Cattle Encephalon Glycoside and Ignotin Injection 10 mg · d ^- 1 were 4333.42 yuan, Cattle Encephalon Glycoside and Ignotin Injection 20 mg · d ^- 1 were 8562.12 yuan, Butylphthalide and Sodium Chloride Injection 8118.32 yuan, respectively. Conclusion Cattle Encephalon Glycoside and Ignotin Injection is considered more economical when not reached maximum dose, but we need more strictly-designed and RCTs of large-scale sample to support our conclusion.