以效益/费用比评估幽门螺杆菌根除方案

Appraising the eradication schemes of Helicobacter pylori with the ratio of utility to cost

目的 对幽门螺杆菌根除方案进行综合评估,为临床医师提供选择参考。方法 对近5年来国内医学期刊报道的数十个幽门螺杆菌(HP)根除方案以HP根除率、疗程(以抗菌药物使用时间为准),不良反应发生率及其严重程度,服药方法等项作为效益(Utility,U)的主要评分指标,并计算抗HP治疗费用(Cost,C)。按U/C比值的大小判定优劣。结果 以方案19(庆大霉素16万U,tid;雷尼替丁0.3g,bid;阿莫西林0.75g,bid;胶态次枸橼酸铋1.0g,qid)和方案20(以四环素0.75g,qid,代替方案19中的阿莫西林,余同方案19)两个二日疗法的四联方案为最佳。结论 效益/费用为一较合理、实用的评估方法,据此筛选出疗程超短、高效、无严重不良反应而又价廉的二日疗法四联方案,但尚待更多病例验证。

Objective To appraise synthetically the eradication schemes of Helicobacter pylori (HP), and provide choice for the physicians. Methods More than twenty eradication schemes of HP reported by domestic medicine periodicals in recent five years were appraised. The evaluating indexes include the eradication rate of HP,course of treatment (according to the duration of taking orally the antimicrobial drugs),side-effect rate and its severity,and the ways of taking drugs,which were considered to be the utility and compared with the cost of anti-HP therapy of every scheme. The judgement depended on the ratio of utility to cost. Results The better schemes are the scheme 19(taking orally gentamycin 160 thousands units,tid;ranitidine 0.3 g,bid; amoxicillin 0.75 g,bid;CBS 1.0 g,qid)and the scheme 20(taking orally tetracycline 0.75 g,qid instead of the amoxicillin of the scheme 19,the others are the same as the former). Both schemes are two-day quadruple therapy. Conclusion The appraisal method of the ratio of utility to cost is rational and practial. The two schemes of short-term quadruple therapy are more effective,lower cost without severe side-effects. But it remains to be confirmed by more studies.