托伐普坦治疗心力衰竭的快速卫生技术评估

Tolvaptan for Heart Failure:A Rapid Health Technology Assessment

目的:利用快速卫生技术评估方法,评价托伐普坦治疗心力衰竭的有效性、安全性和经济性,为临床合理用药和医疗机构遴选新药提供循证依据。方法:系统检索PubMed、the Cochrane Library、CRD database、CNKI、WanFang Data和SinoMed等数据库,搜集有关托伐普坦治疗心力衰竭的系统评价/文献Meta分析、药物经济学研究,检索时限均为从建库至2019年3月,由两名评价者独立筛选文献、提取资料和评价质量后,对结果进行定性分析。结果:纳入9篇系统评价/Meta分析和2篇药物经济学研究。托伐普坦可提高血清钠水平、减轻体重、缓解水肿、可改善呼吸困难、缩短住院时间;增加口干、口渴、尿频、多尿、头晕的发生率;国外的经济学研究表明,托伐普坦减少了住院时间和成本。结论:托伐普坦治疗心力衰竭具有良好的有效性与安全性,在我国应用是否具有经济性尚需进一步研究。

Objective:To evaluate the effectiveness, safety and economy of the clinical use of tolvaptan in the treatment of heart failure, providing evidence for physicians and drug selection by medical institutions.Methods:PubMed, the Cochrane Library, CRD database, CNKI, WanFang Data and SinoMed were systematically searched to collect systematic reviews, Meta-analysis, economics research of tolvaptan in the treatment of heart failure from inception to March 2019. Two reviewers independently identified according to the inclusion criteria, extracted data and assessed quality of included studies. Qualitative analysis were performed. Results:Nine systematic reviews/Meta analysis and two pharmacoeconomic studies were included. Tolvaptan increases serum sodium levels, reduces body weight, relieves edema, improves dyspnea, and shortens hospital stay;increase the incidence of dry mouth, thirst, frequent urination, polyuria, and dizziness;pharmacoeconomic studies abroad had shown that tolvaptan was reduces hospital stay and costs. Conclusion: Tolvaptan is effective and safe in heart failure. Whether it is economical to use in our country still needs to be studied.