帕拉米韦与奥司他韦治疗儿童流行性感冒的临床疗效及药物经济学对比的Meta分析

Comparison of Clinical Effect and Pharmacoeconomics between Peramivir and Oseltamivir in the Treatment of Children with Influenza:a Meta-analysis

背景流行性感冒(以下简称流感)是儿童常见病之一,帕拉米韦静脉滴注和奥司他韦口服是目前临床常用的抗病毒治疗方案,但关于两种治疗方案的疗效、安全性和经济性缺乏循证医学研究。目的系统评价帕拉米韦静脉滴注与奥司他韦口服治疗儿童流感的临床疗效和安全性,并进行药物经济学分析。方法检索Cochrane Library、PubMed、Embase、中国知网(CNKI)、中国生物医学文献数据库(CBM)和万方数据知识服务平台有关帕拉米韦静脉滴注对比奥司他韦口服治疗儿童流感的随机对照试验(RCT),检索时间为建库至2020年5月。并手动检索纳入文献的参考文献中符合本研究要求而上述数据库未收录的文献。由两名研究者严格按照文献纳入与排除标准筛选文献、提取有效内容,并进行文献质量评价。采用RevMan 5.3软件进行Meta分析,并采用成本-效果比(C/E)和增量成本-效果比(ΔC/ΔE)进行药物经济学分析。结果最终纳入11篇文献,涉及1577例患儿;文献质量评价1篇为A级,8篇为B级,2篇为C级。Meta分析结果显示,帕拉米韦组临床有效率(91.52%)高于奥司他韦组(79.16%)〔RR=1.16,95%CI(1.11,1.21),P<0.00001〕;帕拉米韦组不良反应发生率(14.09%)与奥司他韦组(17.58%)比较,差异无统计学意义〔RR=0.80,95%CI(0.62,1.04),P=0.09〕。药物经济学分析结果显示,帕拉米韦组的治疗成本为957元,奥司他韦组的治疗成本为294.35元;帕拉米韦组和奥司他韦组的C/E分别为10.46和3.72;以治疗成本较小的奥司他韦组为对照,计算ΔC/ΔE,为53.61;以帕拉米韦价格下降20%,而奥司他韦价格不变,重新计算C/E和ΔC/ΔE,结果显示,以治疗成本较小的奥司他韦组为对照,计算ΔC/ΔE,为38.13。结论帕拉米韦治疗儿童流感的临床疗效优于奥司他韦,二者用药期间安全性相当,帕拉米韦并未增加药物不良反应发生率,但奥司他韦更具有经济学优势。

Background Influenza is one of the common diseases in children.At present,intravenous infusion of pramivir and oral oseltamivir are commonly used antiviral therapy in clinical practice.However,there is a lack of evidence-based medical research on the efficacy,safety and economics of the two treatment options.Objective To systematically evaluate the efficacy and safety of peramivir intravenous infusion and oral oseltamivir in the treatment of children with influenza,meanwhile to conduct pharmacoeconomic analysis.Methods Randomized controlled trial(RCT)of peramivir intravenous infusion and oral oseltamivir in the treatment of children with influenza were searched in the Cochrane Library,PubMed,Embase,CNKI,CBM,Wanfang Data from the establishment of the database to May 2020.And manually searched the references of the included literatures that were in line with the research of this article but were not included in the above-mentioned database.Two researchers strictly followed the inclusion and exclusion criteria to screen the literature,extract valid data,and evaluate the literature quality.RevMan 5.3 software was used for Meta analysis,and cost-effectiveness ratio(C/E)and incremental cost-effectiveness ratio(ΔC/ΔE)were used for pharmacoeconomic analysis.Results Finally,11 literature were included,involving 1577 children;in the literature quality evaluation,1 article was grade A,8 articles were grade B,and 2 articles were grade C.Meta analysis results showed that,the clinical effective rate(91.52%)of the peramivir group was higher than that of the oseltamivir group(79.16%)〔RR=1.16,95%CI(1.11,1.21),P<0.00001〕;there was no significant difference in the incidence of adverse reactions between the mivir group(14.09%)and the oseltamivir group(17.58%)〔RR=0.80,95%CI(0.62,1.04),P=0.09〕.The results of pharmacoeconomic analysis showed that,the treatment cost of peramivir group was 957 yuan and that of oseltamivir group was 294.35 yuan;the C/E of peramivir group and oseltamivir group was 10.46 and 3.72,respectively;the oseltamivir group,which had a lower treatment cost,was used as a control,andΔC/ΔE was calculated as 53.61;the price of peramivir was reduced by 20%,while the price of oseltamivir remained unchanged,and C/E andΔC/ΔE were recalculated.The results showed that,the oseltamivir group,which had a lower treatment cost,was used as a control,andΔC/ΔE was calculated as 38.13.Conclusion The clinical efficacy of peramivir in the treatment of influenza in children is superior to oseltamivir,and the safety during the period of the two drugs is equivalent.Peramivir does not significantly increase the incidence of adverse drug reactions,but oseltamivir has more economic advantages.