7种口服中成药联合三联疗法治疗幽门螺杆菌相关性消化性溃疡和胃炎的经济学评价

Economic Evaluation of Seven Oral Chinese Patent Medicines Combined with Triple Therapy for Helicobacter Pylori Related Peptic Ulcer and Gastritis

目的比较多种常用口服中成药联合三联常规疗法治疗幽门螺杆菌(helicobacterpylori,Hp)相关性消化性溃疡和胃炎的有效性和经济性。方法通过检索中国期刊全文数据库、万方数据知识服务平台、中文期刊全文数据库、CBM、Pubmed、Embase及Cochrane Library数据库,纳入7种常用口服中成药(荆花胃康胶丸、胃苏颗粒、气滞胃痛颗粒、安胃疡胶囊、加味左金丸、香砂六君子丸、枳术宽中胶囊)联合三联疗法治疗Hp相关性消化性溃疡和胃炎的临床对照试验。根据改良的Jadad量表对纳入研究进行质量评价;采用R和Win BUGS软件进行口服中成药联合三联常规疗法的贝叶斯网状Meta分析,采用Treeage Pro软件构建决策树模型进行成本-效果分析。结果本研究纳入70个研究,网状Meta分析结果显示,以三联为对照,7种口服中成药联合三联疗法均可提高Hp根除率。经济学结果显示,当意愿支付低于60元时,三联疗法具有经济性的概率最高,当意愿支付高于60元时,荆花胃康胶丸联合三联疗法具有经济性的概率最高;当意愿支付高于300元时,荆花胃康胶丸联合三联和胃苏颗粒联合三联两种疗法具有经济性的概率分别稳定在40%、30%附近。结论研究中纳入的中成药联合三联疗法能提高Hp根除率,荆花胃康胶丸联合三联与胃苏颗粒联合三联是其中最可能具有经济性的方案。

Objective To compare the effectiveness and economics of various commonly used oral Chinese patent medicines combined with triple conventional therapy in the treatment of Helicobacter pylori(Hp)-related peptic ulcer and gastritis. Methods By searching CNKI, Wanfang Knowledge Service Platform, Chinese Journal Full-text Database, CBM, Pubmed, Embase and Cochrane Library databases,The clinical controlled trials of seven commonly used oral Chinese patent medicines(Jinghuaweikang capsule, Weisu granule, Qizhiweitong granule, anweiyang capsule, Jiawei Zuojin Pill, Xiangsha Liujunzi pill and Zhizhu Kuanzhong capsule) combined with triple therapy in the treatment of Hp related peptic ulcer and gastritis were included. The quality of the included studies was evaluated according to the modified Jadad scale;R and WinBUGS software were used to conduct Bayesian network meta-analysis of oral Chinese patent medicine combined with triple conventional therapy, and Treeage Pro software was used to build a decision tree model for cost-effectiveness analysis. Results A total of 70 studies were included in this study, and the results of network meta-analysis showed that with triple therapy as the control, 7 kinds of oral Chinese patent medicine combined with triple therapy could improve the eradication rate of H. pylori. The economic results show that when the willingness to pay is lower than 60 yuan, triple therapy has the highest probability of economics;when the willingness to pay is higher than 60 yuan, Jinghua Weikang capsules combined with triple therapy have the highest probability of economics;When the willingness to pay is higher than 300 yuan, the economic probability of Jinghua Weikang capsules combined with Sanlian and Weisu granules combined with triple therapy is stable at around 40% and 30%, respectively. Conclusion The combination of Chinese patent medicines and triple therapy included in the study can improve the eradication rate of H. pylori. Jinghua Weikang capsules combined with triple therapy and Weisu Granules combined with triple therapy are the most economical drugs among them.