变应性鼻炎冲击免疫治疗的临床观察和经济学初探

Clinical observation and preliminary economic study of rush immunotherapy in patients with allergic rhinitis

目的观察变应性鼻炎患者分别采用冲击免疫治疗(rush immunotherapy,RIT)和常规免疫治疗(conventional immunotherapy,CIT)的临床疗效、安全性、患者依从性及成本-效果比,以评价CIT的临床应用意义,并初步探讨其经济学价值。方法选取2019年10月至2020年6月在重庆医科大学附属第一医院耳鼻咽喉科确诊为变应性鼻炎、接受标准化尘螨特异性皮下免疫治疗的患者共72例,其中男39例,女33例,年龄8~60岁。根据患者意愿,分别行RIT或CIT,其中RIT组35例,CIT组37例,对所有研究对象进行为期1年的随访观察。采用视觉模拟量表评分、疗效评估和药物评分评价其临床疗效,采用全身不良反应发生率评价其安全性,采用脱落率评价其患者依从性,采用治疗成本和平均成本-效果比(cost-effectiveness ratio,CER)初步评价其药物经济学价值。结果在治疗半年和1年时,RIT组和CIT组均有显著疗效,且RIT组较CIT组在半年时总有效率更高(76.67%比46.67%,χ2=7.37,P=0.007)。在剂量累加阶段,两组患者全身不良反应发生率无显著差异(8.57%比8.10%,χ2=0.05,P=0.943),而RIT组治疗脱落率显著低于CIT组(0比13.51%,χ2=5.08,P=0.024)。在第1年治疗结束时,RIT组治疗费用高于CIT组[(8163.08±452.67)元比(7385.87±369.92)元,t=-2.78,P=0.009],而两组CER无显著差异[(3298.06±1374.09)元/分比(3154.38±1532.51)元/分,t=-0.36,P=0.418]。结论RIT和CIT均能获得显著临床疗效,均具有良好安全性,单位疗效所花费平均治疗成本相似。RIT早期疗效更显著,患者依从性更高,值得临床推广。

Objective To observe the clinical efficacy,safety,compliance,and cost-effectiveness of rush immunotherapy(RIT)and conventional immunotherapy(CIT)in patients with allergic rhinitis(AR),so as to evaluate the clinical significance of CIT and preliminarily explore its economic value.Methods A study was conducted on 72 AR patients who had received specific immunotherapy from Oct 2019 to Jun 2020 in the Department of Otorhinolaryngology,the First Affiliated Hospital of Chongqing Medical University,including 39 males and 33 females,aging 8 to 60 years.RIT or CIT was performed respectively according to the patients′wishes.There were 35 cases in the RIT group and 37 cases in the CIT group,all subjects were followed up for 1 year.Visual analysis scale(VAS)and effectiveness were used to evaluate the clinical efficacy.Systemic adverse reactions were used to assess safety.Failure rate was calculated to evaluate the compliance.The cost and cost-effectiveness ratio(CER)were conducted to evaluate the health economics preliminarily.Results After half a year and one year′s treatment,both RIT and CIT groups had significant clinical efficacy and RIT group had more significant clinical efficacy than CIT group at half a year(76.67%vs 46.67%,χ2=7.37,P=0.007).During the dose accumulation phase,there was no significant difference in the incidence of systemic adverse reactions between the two groups(8.57%vs 8.10%,χ2=0.05,P=0.943),while the drop-out rate in the RIT group was significantly lower than that in the CIT group(0 vs 13.51%,χ2=5.08,P=0.024).After one year,the costs in RIT group were significantly higher((8163.08±452.67)yuan vs(7385.87±369.92)yuan,t=-2.78,P=0.009),while there was no statistical differences in CER between the two groups((3298.06±1374.09)yuan/point vs(3154.38±1532.51)yuan/point,t=-0.36,P=0.418).Conclusions Both RIT and CIT are beneficial for AR,and they have similar clinical efficacy,safety,and CER.RIT is more effective in the early stage,with higher patient compliance.Thus,RIT is worth promoting and exploring in clinic.