眩晕宁联合甲磺酸倍他司汀治疗内耳缺血相关性眩晕的疗效和药物经济学评价

Curative Effects and Pharmacoeconomic Evaluation of Xuanyunning Combined with Betahistine Mesylate in the Treatment of Vertigo Associated with Inner Ear Ischemia

目的通过观察眩晕宁联合甲磺酸倍他司汀对内耳缺血性眩晕患者治疗前后高刺激听性脑干反应(ABR)和眩晕症状量表评分情况,评价眩晕宁联合甲磺酸倍他司汀治疗内耳缺血性眩晕的有效性和经济学。方法选取2016年2月至2017年11月桂林医学院附属医院神经内科诊收治的120例确诊为后循环缺血(PCI)、良性阵发性位置性眩晕(BPPV)、偏头痛性眩晕(MV)及青少年良性阵发性眩晕患者作为研究对象,随机分为眩晕宁联合甲磺酸倍他司汀组和甲磺酸倍他司汀组,每组60例,疗程两周,比较两组患者治疗前后高刺激ABR检查和眩晕症状程度量表评分的情况进行疗效评价;运用增量成本-效果比(ICER)分析方法对两组的经济学进行分析与评价。结果两组患者治疗前后经高刺激ABR检查,两组组间差异无统计学意义(P>0.05),两组组内左耳、右耳治疗前后Ⅰ~Ⅴ波间期差值比较差异有统计学意义(P<0.05);眩晕宁联合甲磺酸倍他司汀组与甲磺酸倍他司汀组治疗前异常转为治疗后正常的复常率分别为83.61%(51/61)和72.58%(45/62),差异无统计学意义(P=0.140>0.05);两组治疗后眩晕症状量表评分组间比较差异无统计学意义(P>0.05),但均低于治疗前,差异有统计学意义(P<0.05);眩晕宁联合甲磺酸倍他司汀组眩晕症状改善时间和眩晕症状完全缓解时间分别为(2.69±2.11)d、(7.49±3.20)d,单药组眩晕症状改善时间和眩晕症状完全缓解时间分别为(2.95±1.88)d、(8.78±3.12)d,两组组间眩晕症状改善时间差异无统计学意义(P>0.05),眩晕症状缓解时间差异有统计学意义(P<0.05);两组未观察到不良反应;眩晕宁联合甲磺酸倍他司汀组C/E高于甲磺酸倍他司汀组,ICER为1 229.28;单因素敏感性分析显示,眩晕宁联合甲磺酸倍他司汀组的药品C/E仍高于甲磺酸倍他司汀组。结论眩晕宁联合甲磺酸倍他司汀对内耳缺血性眩晕有较好的治疗作用,且眩晕症状完全缓解时间短于甲磺酸倍他司汀组,虽然需要增加成本,每增加1个效果需要多花费1 229.28元,临床治疗中,根据患者的支付意愿选择增加疗效,所产生的费用具有成本-效果优势。

Objective To evaluate the effectiveness and economics of Xuanyunning combined with betahistine mesylate in the treatment of inner ear ischemic vertigo by observing the scores of high stimulating auditory brainstem response(ABR) and vertigo symptom scale before and after treatment. Methods From February 2016 to November 2017, a total of 120 patients with benign paroxysmal vertigo diagnosed as PCI, BPPV, MV and juvenile benign paroxysmal vertigo in the Department of Neurology of the Affiliated Hospital of Guilin Medical College were randomly divided into a Xuanyunning combined with betahistine mesylate group and a betahistine mesylate group, with 60 cases in each group for two weeks. The high stimulation ABR test and the score of vertigo symptom scale were compared between the 2 groups before and after treatment;the incremental cost-effectiveness ratio(ICER) analysis method was used to analyze and evaluate the 2 groups. Results After high stimulation ABR examination before and after treatment, there was no significant difference between the two groups(P>0.05). There was significant difference between the Ⅰ-Ⅴ wave intervals of the left and right ears in the two groups(P<0.05). The normalization rates of vertigo Ning combined with betahistine mesylate group and betahistine mesylate group were 83.61%(51/61) and 72.58%(45/62), respectively(P=0.140>0.05);There was no significant difference in the score of vertigo symptom scale between the two groups after treatment(P>0.05), but they were lower than those before treatment(P<0.05);The improvement time and complete remission time of vertigo symptoms in Xuanyunning combined with betahistine mesylate group were(2.69±2.11) D and(7.49±3.20) d respectively, and the improvement time and complete remission time of vertigo symptoms in single drug group were(2.95±1.88) D and(8.78±3.12) d respectively. There was no significant difference in the improvement time of vertigo symptoms between the two groups(P>0.05), There was significant difference in the remission time of vertigo symptoms(P<0.05);No adverse reactions were observed in the two groups;The C/E of Xuanyunning combined with betahistine mesylate group was higher than that of betahistine mesylate group, and the ICER was 1 229.28;Univariate sensitivity analysis showed that the drug C/E of Xuanyunning combined with betahistine mesylate group was still higher than that of betahistine mesylate group. Conclusion Xuanyunning combined with betahistine mesylate has a better therapeutic effect on inner ear ischemic vertigo, and the onset time and complete remission time of vertigo symptoms are less than that of betahistine mesylate group, which can effectively improve the life experience of patients. Although the cost needs to be increased, each additional effect needs to cost 1 229.28 yuan. In clinical treatment, according to the patient’s willingness to pay, the cost of increasing curative effect has a cost-effectiveness advantage.