常用非酒精性脂肪性肝病药物治疗方案的药物经济学评价

摘要/Abstract

摘要： 目的评估临床常用保肝抗炎药物治疗非酒精性脂肪性肝病(Nonalcoholic fatty liver disease,NAFLD)的药物经济学。方法采用决策树分析模型,率值参数来源于文献资料的Meta分析结果,效果参数来源于专家讨论意见,成本参数(药品规格、使用剂量和单价)来源于文献资料、专家意见及广州市实时药品价格等。观察的治疗方案分别为主要应用还原型谷胱甘肽片(阿拓莫兰)、甘草酸二铵肠溶胶囊(天晴甘平)、盐酸二甲双胍片(格华止)、水飞蓟宾胶囊(水林佳)、双环醇片(百赛诺)、硫普罗宁肠溶片(凯西莱)和多烯磷脂酰胆碱胶囊(易善复)7种药物,疗程均为24周。结果治疗效果以双环醇片最高(8.80),优于还原型谷胱甘肽片(5.70)、甘草酸二铵肠溶胶囊(7.40)、盐酸二甲双胍片(7.10)、水飞蓟宾胶囊(8.00)、硫普罗宁肠溶片(6.80)和多烯磷脂酰胆碱胶囊(7.00);平均成本-效果比：盐酸二甲双胍片最低(166.97),甘草酸二铵肠溶胶囊最高(504.97);与盐酸二甲双胍片比,双环醇片的增量成本-效果比为1219.97,且比其他组均低。以显效率作为产出计算,双环醇片显效率(58.00%)明显高于其他组,与盐酸二甲双胍片相比的增量成本-效果比为32.21。敏感度分析证明这一结果可靠。结论双环醇片可有效治疗非酒精性脂肪性肝病,且具有明显的成本效果优势。

关键词: 非酒精性脂肪性肝病, 保肝抗炎药, 药物经济学, 决策树模型

Abstract: ObjectiveTo investigate the pharmacoeconomics of anti-inflammatory and hepatoprotective drugs in treatment of nonalcoholic fatty liver disease (NAFLD). Methods Decision tree analysis model was carried out in the study, based on rate parameters from meta-analysis, efficacy parameters from expert opinions, as well as cost parameters (drug specifications, dosage and unit price) from the literature, expert opinion and real-time drug prices in Guangzhou, etc. The pharmacoeconomics analysis were performed among 7 treatment regimens for 24 weeks as followed: reduced glutathione tablets (Alto Moran), diammonium glycyrrhizinate capsules (Tianqing Ganping), metformin hydrochloride tablets (Gehua only), silybin capsules (Water forest good), bicyclol tablets (Pisanuo), tiopronin enteric-coated tablets (Kesi Lai) and polyene phosphatidylcholine capsules (Yi Shan Fu). Results Patients with bicyclol tablets treatment showed higher (8.80) therapeutic effect than those with reduced glutathione tablets (5.70), diammonium glycyrrhizinate capsules (7.40), metformin hydrochloride tablets (7.10), silybin capsules (8.00), tiopronin enteric-coated tablets (6.80) and polyenoic phosphatidylcholine capsules (7.00), respectively. The average cost-effectiveness ratio was the lowest (166.97) in metformin hydrochloride tablets, but the highest in diammonium glycyrrhizinate capsules (504.97). Incremental cost-effectiveness ratio of bicyclol tablets was 1219.97, which was lowest among the 7 groups. In terms of efficiency, bicyclol tablets had significantly highest (58.00%) efficacy among the 7 groups, and the incremental cost-effectiveness ratio of bicyclol tablets compared with metformin hydrochloride tablets was 32.21. This result was confirmed by sensitivity analysis. Conclusion Bicyclol tablets is effective in the treatment of NAFLD with a significantly cost-effective advantage.

Key words: Nonalcoholic fatty liver disease, Anti-inflammatory hepatoprotective drugs, Pharmacoeconomics, Decision tree model

陈婷, 叶晓光. 常用非酒精性脂肪性肝病药物治疗方案的药物经济学评价[J]. 肝脏, 2017, 22(9): 794-799.

CHEN Ting, YE Xiao-guang. Pharmacoeconomics evaluation of drug regimen for nonalcoholic fatty liver disease[J]. Chinese Hepatolgy, 2017, 22(9): 794-799.

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