伏立康唑与伊曲康唑治疗慢性阻塞性肺疾病合并肺曲霉菌感染的循证药物经济学评价

Evidence-based pharmacoeconomic evaluation of voriconazole and itraconazole in the treatment of chronic obstructive pulmonary disease with pulmonary aspergillosis

目的:通过Meta分析评价伏立康唑与伊曲康唑治疗慢性阻塞性肺疾病合并肺曲霉菌感染的安全性、有效性和经济性。方法:计算机检索中国知网(CNKI)、万方数据库、维普数据库等中文数据库和PubMed、EMbase、Cochrane Library等英文数据库,检索伏立康唑与伊曲康唑治疗慢性阻塞性肺疾病合并肺曲霉菌感染的临床对照试验,使用RevMan5.3软件进行Meta分析,采用成本-效果分析方法进行经济学评价,并进行单因素敏感性分析和概率敏感性分析。结果:Meta分析结果显示,在疗效方面,伏立康唑优于伊曲康唑(OR=3.40,95%CI:2.22~5.21,P<0.01),在安全性方面,2种方案无显著性差异(OR=0.86,95%CI:0.40~1.84,P=0.70),均具有较好的安全性。药物经济学评价结果显示,相比于伊曲康唑,伏立康唑治疗的增量成本效果比(ICER)值为45928.35元,敏感性分析结果与基本分析结果基本一致,说明基础分析结果较为稳定。结论:伏立康唑治疗慢性阻塞性肺疾病合并肺曲霉菌感染的疗效优于伊曲康唑,但伏立康唑治疗的ICER值过高,因此伊曲康唑治疗慢性阻塞性肺疾病合并肺曲霉菌感染更具有经济性。

OBJECTIVE To evaluate the effectiveness, safety and economy about voriconazole versus itraconazole for treatment of chronic obstructive pulmonary disease with pulmonary aspergillosis based on Meta-analysis.METHODS The data were collected from the PubMed, MEDLINE, EMBASE, Cochrane library, CNKI, Wanfang, Weipu etc through computer. Clinical controlled trials comparing voriconazole with itraconazole in patients with chronic obstructive pulmonary disease with pulmonary aspergillosis were eligible for inclusion. Meta-analysis was performed by using RevMan 5.3 software, while cost-effectiveness analysis was used for economic evaluation. In addition, univariate sensitivity analysis and probabilistic sensitivity analysis were performed.RESULTS Meta-analysis showed that voriconazole was superior to itraconazole in terms of efficacy(effective rate: OR=3.40, 95% CI: 2.22-5.21, P<0.01) and there was no difference between the two therapies in terms of safety(OR=0.86, 95% CI: 0.40-1.84, P=0.70). Pharmacoeconomics evaluation results show that compared to itraconazole, the ICER value of voriconazole was 45 928.35 Yuan, and the sensitivity analysis results were roughly consistent with the basic analysis results, indicating that the basic analysis results were relatively robust.CONCLUSION Voriconazole is superior to itraconazole in the treatment of chronic obstructive pulmonary disease with pulmonary aspergillosis, however, the ICER of voriconazole is much higher compared with itraconazole, so itraconazole is more economical for the treatment of chronic obstructive pulmonary disease with pulmonary aspergillosis.