多糖铁复合物治疗缺铁性贫血的meta分析与成本研究

Polysaccharide iron complex for the treatment of iron deficiency anemia: meta-analysis and cost analysis

目的 评估多糖铁复合物(polysaccharide iron complex,PIC)和其他口服铁剂(硫酸亚铁、琥珀酸亚铁、右旋糖酐铁)治疗缺铁性贫血(iron deficiency anemia,IDA)的相对疗效与经济性。方法 系统检索PIC及其他口服铁剂治疗慢性肾病(chronic kidney disease,CKD)合并IDA、妊娠期IDA及儿童IDA的相关文献,对疗效进行meta分析,构建决策树模型进行成本分析。结果 共检索到169篇文献,最终纳入22篇。在CKD合并IDA患者中,PIC相较硫酸亚铁和琥珀酸亚铁,有效率更高(94%vs 87%vs 85%),不良反应率更低(19%vs 84%vs 88%),平均每位患者12个月总疗程成本可分别节省535元(14%)和1 839元(36%);在妊娠期IDA患者中,PIC相较硫酸亚铁、琥珀酸亚铁及右旋糖酐铁,有效率更高(95%vs 77%vs 80%vs 77%),不良反应率更低(6%vs 38%vs 9%vs 21%),5个月总疗程成本可分别节省270元(17%)、654元(33%)和3 024元(70%);在儿童IDA患者中,PIC相较硫酸亚铁,有效率更高(91%vs 84%),不良反应率更低(8%vs 51%),3个月总疗程成本可节省119元(14%)。敏感性分析显示结果稳健。结论 在3类IDA人群中,PIC相较其他口服铁剂均具有更优疗效及成本节约优势。

Objective To evaluate the comparative efficacy and economic value of polysaccharide iron complex(PIC) and other oral iron supplements(ferrous sulfate,ferrous succinate,iron dextran) in treating iron deficiency anemia(IDA) patients.Methods Published clinical studies of PIC and other oral iron supplements in the treatment of chronic kidney disease(CKD) complicated with IDA,IDA patients during pregnancy,and children with IDA were systematically searched.Meta-analysis was performed to analyze the clinical efficacy.A decision tree model was constructed to perform cost analysis.Results A total of 169 studies were identified,and 22 studies were finally included.For CKD patients with IDA,PIC had higher effective rate(94% vs 87% vs 85%) and lower adverse event(AE) rate(19% vs 84% vs 88%) compared to ferrous sulfate and ferrous succinate.The average total treatment cost per patient was decreased by ￥535(14%) and ￥1 839(36%) respectively in a 12-month treatment course.For pregnant IDA patients,PIC had higher effective rate(95% vs 77% vs 80% vs 77%) and lower AE rate(6% vs 38% vs 9% vs 21%) compared to ferrous sulfate,ferrous succinate and iron dextran.The average total treatment cost was decreased by ￥270(17%),￥654(33%) and 3 024(70%) respectively in a 5-month treatment course.For children with IDA,PIC had higher effective rate(91% vs 84%) and lower AE rate(8% vs 51%) compared to ferrous sulfate and exhibited a cost saving of ￥119(14%) in a 3-month treatment course.Results of sensitivity analysis supported the robustness of the findings.Conclusion For all three types of IDA populations,PIC demonstrated better clinical efficacy and produced cost savings in comparison to other oral iron supplements.