甲状旁腺切除术和药物治疗继发性甲状旁腺功能亢进中的疗效与成本效果分析比较

Efficacy and cost-effectiveness analyses of hyperparathyroidism treated with parathyroidectomy or drugs in secondary hyperparathyroidism patients

目的观察甲状旁腺切除术(parathyroidectomy,PTx)与药物治疗同时在临床应用1年的疗效和成本效果分析。方法回顾性选择2017年1月~2020年12月在玉溪市人民医院接受甲状旁腺切除术[(parathyroidectomy,PTx)和药物治疗的基线数据相似的继发性甲状旁腺功能亢进(secondary hyperparathyroidism,SHPT)患者,收集PTx组、药物治疗组治疗1年后血生化值、临床症状缓解情况、治疗总费用、成本效果分析、生活质量评分及治疗满意度。结果24例患者符合入选条件。①与药物组比较,PTx组治疗3个月、6个月、12个月时全段甲状旁腺激素(intact parathyroid hormone,iPTH)(t值分别为4.046、2.218、2.934,P值分别为0.001、0.038、0.008)、碱性磷酸酶(t值分别为-0.437、0.962、2.536,P值分别为0.666、0.348、0.026)均明显下降;且PTx组的iPTH下降有效率大于药物组(P=0.037)。②治疗3个月、6个月、12个月钙、磷达标率2组之间无明显差异(P值分别为0.684、0.214、0.155,0.667、0.680、0.680)。③PTx组骨痛缓解率优于药物组(P=0.030)。④药物组与PTx随访1年内治疗总费用无明显差异(t=-1.723,P=0.099);药物组成本效果比为6.04,PTx组成本效果比为4.30,手术治疗更具成本效果优势。增量成本效果比显示,与药物组相比,PTx组用于治疗SHPT,每多有效治疗1例患者相对需增加1.87万元成本。⑤PTx组治疗满意度、一般健康状况、精力、躯体疼痛评分优于药物组(t值分别为-4.834、-2.275、-2.169、-3.555,P分别为<0.001、0.033、0.041、0.004)。结论PTx可有效降低iPTH、碱性磷酸酶水平、缓解骨痛,在治疗满意度及生活质量方面优于药物组,2组在1年内治疗费用无明显差异,但手术治疗更具成本效果优势,对于较高iPTH的患者手术治疗可能优于药物治疗。

Objective To observe the efficacy and cost-effectiveness of secondary hyperparathyroidism treated with parathyroidectomy(PTx)or drugs for one year.Methods Patients with secondary hyperparathyroidism who underwent PTx and those with similar baseline who underwent drug therapy in Yuxi People's Hospital from January 2017 to December 2020 were retrospectively reviewed.Blood biochemical values,improvement of clinical symptoms,total medical expenses,cost-effectiveness analysis,scores of the quality of life,and treatment satisfaction were collected in PTx patients and drug treatment patients after the treatments for one year.Results A total of 24 secondary hyperparathyroidism patients were eligible for the analyses.①Serum iPTH and alkaline phosphatase levels decreased more in the PTX group than in the drug therapy group after the treatment for 3,6 and 12 months(for iPTH:t=4.046,2.218 and 2.934 respectively,P=0.001,0.038 and 0.008 respectively;for alkaline phosphatase:t=-0.437,0.962 and 2.536 respectively,P=0.666,0.348 and 0.026 respectively);the effective iPTH decrease rate was higher in the PTx group than in the drug therapy group(P=0.037).②The compliant rates of serum calcium and phosphorus had no significant differences between the two groups after the treatments for 3,6 and 12 months(for serum calcium:P=0.684,0.214 and 0.155 respectively;for serum phosphorus:P=0.667,0.680 and 0.680 respectively).③The improvement rate of bone pain was higher in the PTX group than in the drug therapy group(P=0.030).④The total medical expenses in the follow-up period of one year were similar in the two groups(3.523±1.138 vs.4.303±1.088×103 yuan,t=-1.723,P=0.099).The cost-effectiveness ratio was 6.04 in the drug therapy group,and was 4.30 in the PTx group,indicating the superiority of PTx to drug therapy.The incremental cost-effectiveness ratio showed that every secondary hyperparathyroidism patient effectively treated by PTX required an additional cost of 18,700 yuan as compared with the expenses of drug treated patients.⑤The scores of treatment satisfaction,general health status,energy,and body pain were better in the PTX group than in the drug therapy group(t=-4.834,-2.275,-2.169 and-3.555 respectively;P<0.001,0.033,0.041 and 0.004 respectively).Conclusion PTx can effectively reduce the levels of iPTH and alkaline phosphatase and relieve bone pain,and is superior to drug therapy in terms of treatment satisfaction and quality of life.There was no significant difference in treatment cost between the two groups within one year,but surgical treatment was more cost-effective.For patients with higher iPTH,PTx may be superior to drug therapy.