中西含漱液结合治疗慢性牙周炎的成本-效果和成本-效用分析

Cost-effectiveness and cost-utility of Chinese and Western gargles for chronic periodontitis patients

目的:运用成本-效果和成本-效用2种方法,对3种牙周炎治疗方案进行经济学分析,为临床治疗牙周炎提供依据。方法:将106例牙周炎患者随机分为3组,均进行牙周基础治疗,其中38例患者在基础治疗上联合复方氯己定含漱液,35例联合复方氯己定含漱液和西帕依固龈液,33例联合复方氯己定含漱液和康复新含漱液,收集患者基本信息、治疗成本、牙周治疗有效率及EQ-5D-3L量表评分。按照总成本(C)/有效率(E)计算成本-效果比(CER),进行成本-效果分析;通过EQ-5D-3L中国效应值积分体系换算牙周炎患者的健康效用值,根据公式计算质量调整生命年(QALYs)=报告生存时间×健康效用值,计算成本-效用比(CUR)=总成本(C)/QALYs,进行成本-效用分析。结果:比较各组牙周炎治疗前后的有效率,治疗后3组的有效率分别是78.95%、91.43%和87.88%(H=6.753,P=0.034),具有显著性差异;成本-效果比是1629.98、1486.94、1516.52;治疗前3组效用值分别是0.92、0.89、0.90,康复治疗后的效用值分别是0.98、0.98、0.97,3组的成本-效用比是270.180、190.41、240.13。牙周炎患者每提高一个有效率和一个QALYs,治疗费用低于江苏省人均GDP,表示治疗费用完全值得。成本-效果比和成本-效用比结果相同,均为复方氯己定联合西帕依固龈液组最低,表示达到同样治疗效果时,复方氯己定联合西帕依固龈液组花费最少。结论:牙周炎患者进行牙周基础治疗时,联合复方氯己定含漱液和西帕依固龈液,可以显著提高牙周治疗有效率,更具有经济性。

OBJECTIVE To compare three kinds of periodontitis care schemes through cost-effectiveness and cost-utility to provide rationales for a proper treatment of periodontitis.METHODS A total of 106 patients with periodontitis were randomized into 3 groups to receive basic periodontal treatment plus compound chlorhexidine gargle(n=38),compound chlorhexidine gargle plus Sipaii gingival consolidation solution(n=35)and compound chlorhexidine gargle plus Kangfuxin gargle(n=33).Baseline profiles,treatment expenses,effective rate and EQ-5D-3L scale score were recorded.Cost-effectiveness and cost-utility analyses were performed.Cost-effectiveness ratio(CER)was based upon total cost(C)/efficiency(E)and cost-utility.Health utility values were converted by EQ-5D-3L China effect value score system.Quality-adjusted life years(QALYs)=reported survival time×health utility value.And cost-utility ratio(CUR)=total cost(C)/QALYs.RESULTS The effective rates before and after treatment were compared among three groups.After treatment,the effective rates of three groups were 78.95%,91.43%and 87.88%(H=6.753,P=0.034).There were significant differences.Cost-effectiveness ratio was 1629.98,1486.94 and 1516.52;Before treatment,utility values of three groups were 0.92,0.89 and 0.90;After rehabilitation,utility values were 0.98,0.98 and 0.97,respectively.Cost-utility ratio of three groups was 270.18,190.41 and 240.13.Treatment expense was lower than per capita GDP of Jiangsu Province for each increment of one effective rate and one QALYs.It indicated that treatment cost was completely worthwhile.The ratios of cost-effectiveness and cost-utility were similar.Both were the lowest in compound chlorhexidine plus Xipayi gingival consolidation fluid group.It indicated that compound chlorhexidine plus Xipayi gingival consolidation fluid group achieved the same therapeutic effect with a minimal expense.CONCLUSION For periodontitis patients receiving basic periodontal basic care,a combination of compound chlorhexidine gargle and Xipayi gingival solidifying solution may significantly improve the efficiency and economy of periodontal treatment.