麝香保心丸与复方丹参滴丸治疗冠状动脉粥样硬化性心脏病心绞痛的药物经济学评价

A Pharmacoeconomic Evaluation of Shexiang Baoxin Pills and Compound Danshen Dripping Pills in The Treatment of Coronary Heart Disease

目的系统评价麝香保心丸与复方丹参滴丸治疗冠状动脉粥样硬化性心脏病心绞痛的有效性,以及两者的成果-效果。方法检索国内外已发表的麝香保心丸与复方丹参滴丸对冠状动脉粥样硬化性心脏病进行治疗的随机对照试验(RCT)文献,进行质量评价后,采用Stata 16.0软件进行荟萃分析,并结合我国各省市药物价格进行经济学评价。结果本研究最终纳入18篇文献,包含1261例患者。麝香保心丸相对于复方丹参滴丸,对改善患者症状的有效率差为14%(95%CI:4%~24%,P=0.01)。麝香保心丸相对于复方丹参滴丸,对改善患者心电图有效率差为27%(95%CI:12%~42%,P<0.001)。从全国平均水平上看,与复方丹参滴丸相比,麝香保心丸在改善临床症状方面的增量成本-效果比为-18.00,在改善心电图结果方面的增量成本-效果比则为-14.82,麝香保心丸的药品成本更低,但在改善临床症状和心电图结果方面的效果更好。结论麝香保心丸在改善冠状动脉粥样硬化性心脏病心绞痛患者症状、心电图结果的效果优于复方丹参滴丸。对比复方丹参滴丸,麝香保心丸具有经济性优势。

Objective To evaluate the efficacy and economy of Shexiang Baoxin Pills and Compound Danshen Dripping Pills in treating coronary heart disease.Methods The literature published on randomized controlled trials(RCTs)of Shexiang Baoxin Pill(treatment group)and Compound Danshen Dripping Pills(control group)in the treatment of coronary heart disease were included.After screening the literature and performing the quality evaluation,Stata 16.0 software was used for meta-analysis,and pharmacoeconomic evaluation was performed based on the results of this analysis.Results Eighteen articles involving 1261patients were finally included.Compared with compound Danshen dripping pills,the effective rate of Shexiang Baoxin Pills was 14%(95%CI:4%~24%,P=0.01).Compared with compound Danshen dripping pills,the effective rate of ECG of Shexiang Baoxin Pills was 27%(95%CI:12%~42%,P<0.001),indicating that the effective rate of symptom improvement and ECG improvement of Shexiang Baoxin Pills was significantly better than that of compound Danshen dripping pills.Overall,compared with the control group,the incremental cost-effectiveness ratio of the treatment group in improving clinical symptoms was-18.00,and the incremental cost-effectiveness ratio of the treatment group in improving ECG results was-14.82;due to the different prices of drugs in different regions of the domestic market,for most provinces,the incremental cost-effectiveness ratio of the treatment group in improving clinical symptoms and improving ECG results was negative.Conclusion Shexiang Baoxin Pills are superior to Compound Danshen Dripping Pills in improving the symptoms and ECG of patients with coronary heart disease.Overall,Shexiang Baoxin Pills has absolute economic advantages.In some provinces,patients can choose the dominant scheme according to the price of drugs.