特利加压素与去甲肾上腺素治疗肝肾综合征药物经济学评价

Pharmacoeconomic Evaluation of Terlipressin Versus Noradrenaline in the Treatment of Hepatorenal Syndrome

目的评价特利加压素和去甲肾上腺素治疗肝硬化肝肾综合征的经济学效果。方法采用循证医学的方法收集特利加压素和去甲肾上腺素治疗肝硬化肝肾综合征的随机对照临床试验,进行meta分析并得到相应的肝肾综合征缓解率、30 d存活率及不良反应发生率,以决策树模型进行成本-效果分析。结果有6个随机对照临床研究(225例患者)纳入meta分析,特利加压素和去甲肾上腺素联合白蛋白治疗肝肾综合征的缓解率和30 d存活率差异无统计学意义,两者疗效相当,但去甲肾上腺素组不良反应发生率低于特利加压素组。特利加压素组和去甲肾上腺素组期望成本分别为8 085.92元和890.37元。敏感性分析显示结果稳定。结论去甲肾上腺素联合白蛋白治疗肝硬化肝肾综合征的治疗方案具有成本效果优势,建议国家医保部门可以将该方案纳入全额医保,减轻患者的医疗负担。

OBJECTIVE To compare the efficacy and costs of terlipressin and noradrenaline for the treatment of patients with cirrhosis and hepatorenal syndrome（HRS）. METHODS Evidence-based medicine method was used to collect randomized-controlled trials for treatment of HRS with terlipressin and noradrenaline. Meta-analysis was performed to obtain the rate of HRS reversal, 30 d survival and adverse events. Economic evaluation was carried out by decision tree model. RESULTSSix randomized-controlled trials（225 patients） were included in the meta-analysis. There was no difference between treatments with terlipressin or noradrenaline in terms of HRS reversal and 30 d survival, had therapeutic equivalence. The rate of adverse reaction were less lower in noradrenaline group compared with terlipressin group. Expected costs of treatment with terlipressin and norepinephrine were 8 085.92 yuan and 890.37 yuan, respectively. Sensitivity analysis showed that the results were stable. CONCLUSION Noradrenaline combined with albumin has a cost-effectiveness superiority in the treatment of liver cirrhosis and HRS. It is recommended that the national health insurance department take the program into full-payout medical insurance and reduce the medical burden of the patients.