第二类精神药品治疗失眠症的使用状况与药物经济学评价

The Use and Pharmacoeconomic Evaluation of Class II Psychotropic Drugs in the Treatment of Insomnia

目的探讨3种第二类精神药品治疗失眠症的使用状况及其成本-效果,为规范第二类精神药品的使用提供参考。方法回顾性分析2018年中山市第三人民医院门诊使用3种常见第二类精神药品(艾司唑仑片、酒石酸唑吡坦片、佐匹克隆胶囊)治疗失眠症的状况,对用药频度(DDDs)、药物利用指数(DUI)、日均费用(DDDc)、使用强度(AUD)等指标进行比较,评估这3种第二类精神药品在治疗失眠症方面使用状况及其经济学效价。结果艾司唑仑片的DDDs显著高于其他两种药品,但DUI显著低于其他两种药品,其中酒石酸唑吡坦片的DDDs最低,佐匹克隆胶囊的DUI最高,差异有统计学意义(P<0.05);佐匹克隆胶囊和酒石酸唑吡坦片的DDDc显著高于艾司唑仑片,但AUD显著低于艾司唑仑片,差异有统计学意义(P<0.05);虽然佐匹克隆胶囊和酒石酸唑吡坦片的DDDc比较差异无统计学意义(P>0.05),但是酒石酸唑吡坦片的AUD显著低于佐匹克隆胶囊(P<0.05)。由于艾司唑仑片的单价较低,从单人月均成本-效果比角度来看,艾司唑仑片显著低于佐匹克隆胶囊和酒石酸唑吡坦片(P<0.05),酒石酸唑吡坦片低于佐匹克隆胶囊(P<0.05)。利用增量成本-效益分析法进行多重比较分析发现,3种药品的月均增量成本-效益比差异无统计学意义(P>0.05)。结论 3种第二类精神药品治疗失眠症的使用状况存在显著差异,月均成本-效果比也有显著差异,但却不影响月均增量成本-效益,临床医师可根据临床需要进行选择使用。

Objective To analyze the use status and cost status of 3 kinds of psychotropic drugs in the treatment of insomnia, and to provide reference for standardizing the use of psychotropic drugs in the second category. Methods A retrospective analysis was made on the treatment of insomnia with 3 common psychotropic drugs(Estazolam tablets, Zolpidem tartrate tablets, Zopiclone capsules) in the outpatient department of Zhongshan Third People’s Hospital in 2018. The DDDs, DUI, DDDc and AUD were compared, in order to evaluate the use and economic efficacy of the 3 psychotropic drugs in the treatment of insomnia. Results The DDDs of Estazolam Tablets were significantly higher than those of the other 2 drugs, but the DUI of Estazolam Tablets was significantly lower than that of other drugs. Among them, the DDDs of Zolpidem Tartrate Tablets was the lowest, and the DUI of Zopiclone Capsules was the highest and the difference was statistically significant(P<0.05). TheDDDc of zopiclone capsules and zolpidem tartrate tablets was significantly higher than that of Estazolam tablets, but the AUD was significantly lower than that of Estazolam tablets. The difference was statistically significant(P<0.05). Although there was no statistical difference in DDDc between zopiclone capsules and zolpidem tartrate tablets(P>0.05), the AUD of zolpidem tartrate tablets was significantly lower than that of zopiclone capsules. The differences are statistically significant(P<0.05). Due to the low unit price of estazolam tablets, from the perspective of monthly cost-effectiveness ratio per person, estazolam tablets were significantly lower than zopiclone capsules and zolpidem tartrate tablets(P<0.05). Pitan tablets were lower than Zopiclone capsules(P<0.05). Multiple comparison analysis using incremental cost-benefit analysis found that there was no statistically significant difference in the monthly average incremental costbenefit ratio of the 3 drugs(P>0.05). Conclusion There is a significant difference in the use of the Class II psychoactive drugs in the treatment of insomnia, and there is also a significant difference in the monthly average cost-effectiveness ratio. But it does not affect the monthly average incremental cost effects. Clinicians can choose to use them according to clinical needs.