艾司奥美拉唑治疗非静脉曲张性上消化道出血的疗效及药物经济学分析
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摘要
目的:对比奥美拉唑、泮托拉唑、兰索拉唑及艾司奥美拉唑4种质子泵抑制剂治疗非静脉曲张性上消化道出血的疗效和药物经济学。方法:选取2015年9月至2017年9月河南省驻马店市中心医院非静脉曲张性上消化道出血的患者113例,随机分为奥美拉唑组(28例)、泮托拉唑组(20例)、兰索拉唑组(30例)及艾司奥美拉唑组(35例),分别给予奥美拉唑、泮托拉唑、兰索拉唑及艾司奥美拉唑4种质子泵抑制剂治疗,比较各组止血时间、疗效和药物经济学。结果:在止血时间方面,艾司奥美拉唑组显著低于奥美拉唑组、泮托拉唑组和兰索拉唑组(P<0.05);在疗效方面,各组之间差异无统计学意义(P>0.05);采用成本-效果分析法进行经济学研究,艾司奥美拉唑组(C/E=14.22)高于奥美拉唑组(C/E=2. 14)、泮托拉唑组(C/E=5.58)和兰索拉唑组(C/E=11.94)。结论:在止血时间方面,艾司奥美拉唑较奥美拉唑、泮托拉唑和兰索拉唑具有明显优势。但在药物经济学方面,艾司奥美拉唑治疗非静脉曲张性上消化道出血经济学成本最高。
Objective: To compare the curative effect and cost-effectiveness of four different proton pump inhibitors(PPIs), omeprazole,pantoprazole. lansoprazole, and esomeprazole, in the treatment of non-vricose upper gstrointestinal bleeding. Methods: A total of 113 cases of non-varicose upper gastrointestinal bleeding patients treated in Zhumadian Central Hospital from September 2015 to September 2017, were randomly divided into omeprazole group, pantoprazole group, lansoprazole group, and esomeprazole group, and treated with the regimen of omeprazole, pantoprazole, lansoprazole, and esomeprazole, respectively. The hemostasis time, curative effect, and cost-effectiveness analysis was used to investigate the four regimens. Results: The hemostasis time in esomeprazole group was significantly lower than the other three groups(P<0.05); the total curative effect in four different groups had no statistical significant difference(P>0.06); the cost-effectiveness analysis showed that cost-effectiveness ratio(C/E) of omeprazole group was 14 22, omeprazole group was 2.14, pantoprazole group was 5.58, and lansoprazole group was 11.94. Conclusion: Esomeprazole can reduce the hemostasis time in non-varicose upper gastrointestinal bleeding patients obviously. However, considering from the perspective of pharmacoeconomics, the cost-effectiveness of esomeprazole is higher than the other three PPIs.
Objective: To compare the curative effect and cost-effectiveness of four different proton pump inhibitors(PPIs), omeprazole,pantoprazole. lansoprazole, and esomeprazole, in the treatment of non-vricose upper gstrointestinal bleeding. Methods: A total of 113 cases of non-varicose upper gastrointestinal bleeding patients treated in Zhumadian Central Hospital from September 2015 to September 2017, were randomly divided into omeprazole group, pantoprazole group, lansoprazole group, and esomeprazole group, and treated with the regimen of omeprazole, pantoprazole, lansoprazole, and esomeprazole, respectively. The hemostasis time, curative effect, and cost-effectiveness analysis was used to investigate the four regimens. Results: The hemostasis time in esomeprazole group was significantly lower than the other three groups(P<0.05); the total curative effect in four different groups had no statistical significant difference(P>0.06); the cost-effectiveness analysis showed that cost-effectiveness ratio(C/E) of omeprazole group was 14 22, omeprazole group was 2.14, pantoprazole group was 5.58, and lansoprazole group was 11.94. Conclusion: Esomeprazole can reduce the hemostasis time in non-varicose upper gastrointestinal bleeding patients obviously. However, considering from the perspective of pharmacoeconomics, the cost-effectiveness of esomeprazole is higher than the other three PPIs.
引文
[1] De Groot N L, Hagenaars M P, Smeets H M, et al.Primary nonvariceal upper gastrointestinal bleeding in NSAID and low-dose aspirin users:development and validation of risk scores for either medication in two large Dutch cohorts[J].J Gastroenterol, 2014,49(2):245-253.
[2] Rotondano G, Cipolletta L, Koch M, et al.Predictors of favourable outcome in non-variceal upper gastrointestinal bleeding:implications for early discharge[J]. Dig Liver Dis, 2014, 46(3):231-236.
[3]中华医学会内镜学分会.急性非静脉曲张性上消化道出血诊治指南[J].中华消化杂志,2015, 35(12):793-798.
[4]李延青.亚太地区非静脉曲张性上消化道出血专家共识意见解读(六):药物治疗[J].中华消化杂志,2012, 32(3):149-150.
[5]江学容,成小蔓.国家基本药物中口服降糖药的药物经济学分析[J].中华内分泌代谢杂志,2011, 27(12):1021-1024.
[6]刘国恩,胡善联,等.中国药物经济学评价指南(2011版)[J].中国药物经济学,2011,5(2):42-43.
[7]Gralnek I M, Dumonceau J M, Kuipers E J, et al.Diagnosis and management of nonvariceal upper gastrointestinal hemorrhage European Society of Gastrointestinal Endoscopy(ESGE)Guideline[J].Endoscopy, 2015. 47(10):1-46.
[8] Aguilera-Castro L, Martín-de-Argila-dePrados C, Albillos-Martínez A.Practical considerations in the management of proton-pump in-hibitors[J].Rev Esp Enferm Dig, 2016, 108(3):145-153.
[9] De Smet J, Boussery K, De Cock P, et al.A bio-analytical hydrophilic interaction LC-MS/MS method for the simultaneous quantification of omeprazole and lansoprazole in human plasma in support of a pharmacokinetic omeprazole study in children[J] J Sep Sci, 2010, 33(6-7):939-947.
[10]曾晓晖,石磊,关慧,等.液相色谱-串联质谱法测定人血浆中兰索拉唑及其代谢物浓度[J].中国临床药理学杂志,2012, 28(2):135-138.
[11] Gopinath S, Kumar R S, Shankar M B, et al.Development and validation of a sensitive and high-throughput LC-MS/MS method for the simultaneous determination of esomeprazole and naproxen in human plasma[J].Biomed Chromatogr, 2013, 27(7):894-899.
[12]李海涛,李士雪,夏慧,等.利用药物经济学评价指导临床合理用药的探讨[J].中国医院管理,2007, 27(3):45-47.
[2] Rotondano G, Cipolletta L, Koch M, et al.Predictors of favourable outcome in non-variceal upper gastrointestinal bleeding:implications for early discharge[J]. Dig Liver Dis, 2014, 46(3):231-236.
[3]中华医学会内镜学分会.急性非静脉曲张性上消化道出血诊治指南[J].中华消化杂志,2015, 35(12):793-798.
[4]李延青.亚太地区非静脉曲张性上消化道出血专家共识意见解读(六):药物治疗[J].中华消化杂志,2012, 32(3):149-150.
[5]江学容,成小蔓.国家基本药物中口服降糖药的药物经济学分析[J].中华内分泌代谢杂志,2011, 27(12):1021-1024.
[6]刘国恩,胡善联,等.中国药物经济学评价指南(2011版)[J].中国药物经济学,2011,5(2):42-43.
[7]Gralnek I M, Dumonceau J M, Kuipers E J, et al.Diagnosis and management of nonvariceal upper gastrointestinal hemorrhage European Society of Gastrointestinal Endoscopy(ESGE)Guideline[J].Endoscopy, 2015. 47(10):1-46.
[8] Aguilera-Castro L, Martín-de-Argila-dePrados C, Albillos-Martínez A.Practical considerations in the management of proton-pump in-hibitors[J].Rev Esp Enferm Dig, 2016, 108(3):145-153.
[9] De Smet J, Boussery K, De Cock P, et al.A bio-analytical hydrophilic interaction LC-MS/MS method for the simultaneous quantification of omeprazole and lansoprazole in human plasma in support of a pharmacokinetic omeprazole study in children[J] J Sep Sci, 2010, 33(6-7):939-947.
[10]曾晓晖,石磊,关慧,等.液相色谱-串联质谱法测定人血浆中兰索拉唑及其代谢物浓度[J].中国临床药理学杂志,2012, 28(2):135-138.
[11] Gopinath S, Kumar R S, Shankar M B, et al.Development and validation of a sensitive and high-throughput LC-MS/MS method for the simultaneous determination of esomeprazole and naproxen in human plasma[J].Biomed Chromatogr, 2013, 27(7):894-899.
[12]李海涛,李士雪,夏慧,等.利用药物经济学评价指导临床合理用药的探讨[J].中国医院管理,2007, 27(3):45-47.