奥普力农与米力农治疗急性心力衰竭的循证药物经济学

Evidence-based Pharmacoeconomics Analysis of Olprinone and Milrinone in the Treatment of Acute Heart Failure

目的评价奥普力农与米力农治疗充血性心力衰竭急性发作的疗效、安全性与经济学。方法纳入奥普力农与米力农治疗充血性心力衰竭的临床对照研究,进行质量评价与数据分析,采用Rev Man5.0软件进行Meta分析,研究两组药物的疗效与安全性差异,并采用Tree Age Pro 2011构建决策树模型评价两组药物的经济学。结果 1)有效率:奥普力农高于米力农(89.8%比79.1%,P=0.004)。2)不良反应发生率:奥普力农显著低于米力农(11.0%比26.6%,P<0.001)。3)死亡率:奥普力农死亡率显著低于米力农(16.6%比20.9%,P=0.03)。4)奥普力农1 906元/5 mg的有效率成本-效果比:奥普力农组=48 642.2元,CER米力农=30 525.3元,奥普力农需降价至639元/5 mg可达到米力农的成本-效果比。5)奥普力农1 906元/5 mg的安全性成本-效果比:奥普力农组=49 188.7元,米力农=33 034.2元,增量成本-效果比(ICER)=122 893.8元,奥普力农需降价至788元/5 mg可达到米力农的成本-效果比。6)奥普力农降价至500元/5 mg的有效率成本-效果比:奥普力农组=28 584元,米力农=30 525.3元,ICER=14 118.2元,提示奥普力更具有经济学,且敏感性分析显示,奥普力农最高的成本-效果比仍低于米力农最低成本-效果比(29 304元比29 865元),说明奥普力农药物经济学仍优于米力农结果稳定。结论奥普力农治疗充血性心力衰竭急性发作有效率优于米力农,不良反应发生率、死亡率低于米力农。奥普力农在1 906元/5 mg前提下经济学不如米力农,如需达到米力农相同的经济学需降价至639元/5 mg,如奥普力农降价至500元/5 mg,奥普力相比米力农则更具有经济学,且结果稳定。

Objective To evaluate the efficacy, safety and economy of olprinone and milrinone in the treatment of acute heart failure. Methods A clinical controlled study of oprinone and milrinone in the treatment of congestive heart failure was included, quality evaluation and data analysis were carried out, and RevMan 5.0 software was used for Meta analysis to study the difference in efficacy and safety of the 2 drugs, and TreeAge Pro 2011 was used t construct a decision tree model to evaluate the economics of the 2 groups of drugs. Results 1) Efficacy: the efficacy rate of olprinone was higher than milrinone(89.8% vs 79.1%, P=0.004). 2) Adverse reactions: olprinone had significantly lower frequency of adverse events than milrinone(11.0% vs 26.6%, P<0.001);3) death rate: the death rate of olprinone was significantly lower than milrinone(16.6% vs 20.9%, P=0.03). 4) The effective cost-effectiveness ratio of oprinone 1 906 yuan/5 mg: oprinone=48 642.2 yuan, CER milrinone=30 525.3 yuan, and oprinone needs to be reduced to 639 yuan/5 mg and can reach the cost-effectiveness ratio of milrinone. 5) The safety cost-effectiveness ratio of oprinone was 1 906 yuan/5 mg: oprinone= 49 188.7 yuan, milrinone=33 034.2 yuan, and incremental cost-effectiveness ratio(ICER)=122 893.8. The price of oprinone needs to be reduced to 788 yuan/5 mg to achieve the cost-effectiveness ratio of milrinone. 6) The cost-effectiveness ratio of oprinone reduced to 500 yuan/5 mg: oprinone=28,584 yuan, milrinone=30 525.3 yuan, ICER=14 118.2 yuan, suggesting that oprinone had more economics and sensitivity analysis showed that the highest cost-effectiveness ratio of oprinone was still lower than the lowest cost-effectiveness ratio of milrinone(29 304 yuan to 29 865 yuan), indicating that oprinone pharmacoeconomics is still better than milrinone, and the result is stable. Conclusion Optrinone is more effective than milrinone in the treatment of acute episodes of congestive heart failure, and the incidence of adverse reactions and mortality are lower than milrinone. Optrinone is inferior to milrinone in economics under the premise of 1 906 yuan/5 mg. To achieve the same economics as milrinone, the price must be reduced to 639 yuan/5 mg. For example, the price of oprinone is reduced to 500 yuan/5 mg. mg, Opuli is more economical than milrinone, and the results are stable.