乳腺良性肿块麦默通围手术期应用尖吻蝮蛇血凝酶的药物经济学分析
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摘要
目的探讨乳腺良性肿块麦默通(MMT)微创旋切术围手术期使用尖吻蝮蛇血凝酶(HCA)的药物经济学。方法 2017年1—12月胸外乳腺科240例符合纳入标准的乳腺良性肿块患者,随机分成甲、乙两组,各120例;入院后所有患者均行MMT微创旋切术,甲组术前静脉推注HCA 2 U 1次,乙组MMT术前不用HCA;两组比较平均术中出血量、术中出血率、术后出血率、治疗有效率、不良反应发生率、住院平均天数、平均药物费用和平均给药费用,最后进行成本-效果分析。结果两组平均术中出血量、术中出血率、术后出血率、不良反应发生率、住院平均天数差异均无统计学意义(P>0.05),但甲组的平均药物费用和平均给药费用均显著高于乙组(P<0.01),乙组具有成本-效果优势。结论术前使用HCA预防乳腺良性肿块MMT微创旋切术出血无明显疗效,安全性好,但经济性差。
Objective To investigate the pharmacoeconomics of haemocoagulase agkistrodon(HCA) in perioperative period of breast benign tumor treated with mammotome(MMT) system. Methods Totally, 240 patients with breast benign tumor undergoing minimally invasive MMT resection from January to December in 2017 were assigned to group A(HCA 2 U before MMT, 120 cases) and group B(HCA 0 U before MMT, 120 cases). The average intraoperative mean blood loss, incidence of intraoperative hematoma, incidence of postoperative hematoma and adverse reactions, average length of hospital stay, drug costs and administration costs were observed and the cost-effectiveness analysis was conducted. Results There were no significant differences between the two groups in the intraoperative mean blood loss and the incidence of intraoperative hematoma, the incidence of postoperative hematoma and treatment effective rate, adverse reactions and average length of hospital stay inpatient drug costs inpatient drug costs(P>0.05), but the average drug costs and administration costs significantly higher in group A than in group B(P<0.01). Group B showed cost-effectiveness advantage. Conclusion Preoperative use of HCA for the treatment of benign breast tumor with MMT minimally invasive resection to prevent bleeding is not obviously efficient, but safe and less economical.
Objective To investigate the pharmacoeconomics of haemocoagulase agkistrodon(HCA) in perioperative period of breast benign tumor treated with mammotome(MMT) system. Methods Totally, 240 patients with breast benign tumor undergoing minimally invasive MMT resection from January to December in 2017 were assigned to group A(HCA 2 U before MMT, 120 cases) and group B(HCA 0 U before MMT, 120 cases). The average intraoperative mean blood loss, incidence of intraoperative hematoma, incidence of postoperative hematoma and adverse reactions, average length of hospital stay, drug costs and administration costs were observed and the cost-effectiveness analysis was conducted. Results There were no significant differences between the two groups in the intraoperative mean blood loss and the incidence of intraoperative hematoma, the incidence of postoperative hematoma and treatment effective rate, adverse reactions and average length of hospital stay inpatient drug costs inpatient drug costs(P>0.05), but the average drug costs and administration costs significantly higher in group A than in group B(P<0.01). Group B showed cost-effectiveness advantage. Conclusion Preoperative use of HCA for the treatment of benign breast tumor with MMT minimally invasive resection to prevent bleeding is not obviously efficient, but safe and less economical.
引文
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[13] 雷蕾,徐久东,冯国斌,等.麦默通乳腺微创手术术中、术后出血的原因分析及防治[J].西南军医,2012,14(5):702-704.
[14] 石鹤坤,李小玲,林小凤,等.尖吻蝮蛇血凝酶用于手术创口止血效果的Meta分析[J].药物流行病学杂志,2015,24(5):274-278.
[15] 郭娜,韩晟,管晓东,等.神经外科手术应用尖吻蝮蛇血凝酶的经济性研究[J].中国药房,2016,27(2):163-165.
[16] 罗彬,杨健.尖吻蝮蛇血凝酶在腹部手术中的应用研究[J].中国医药指南,2015,13(3):19-20.
[17] 谢丹,杨海燕,黄梅,等.麦默通乳腺微创术后血肿形成的预防[J].广西医学,2007,29(5):705.
[18] 卢振群,李明,徐红.超声引导下乳腺肿物微创旋切术的应用进展[J].中华灾害救援医学,2014,2(4):227-231.
[19] DING B,CHEN D,LI X,et al.Meta analysis of efficacy and safety between mammotome vacuum-assisted breast biopsy and open excision for benign breast tumor[J].Gland Surg,2013,2(2):69-79.
[20] 白雪,杜峻峰,苑树俊,等.手术后应用尖吻蝮蛇血凝酶止血的安全性评价[J].中国临床药理学杂志,2011,27(4):255-258.
[2] OHSMI S,TAIRA N,TAKABATAKE D,et al.Breast biopsy for mammographically detected nonpalpable lesions using a vacuum-assisted biopsy device(Mammotome) and upright-type stereotactic mammography unit without a digital imaging system:experience of 500 biopsies[J].Breast Cancer,2014,21(2):123-127.
[3] 闫存礼,侯林都.乳腺肿块麦默通微创旋切术后出血防治的体会[J].吉林医学,2014,35(10):2185-2186.
[4] 万文博,王知力,李俊来,等.乳腺真空辅助旋切术后并发血肿的预后及影响因素分析[J].中国医学影像学杂志,2014,22(10):735-738.
[5] 高忠诚,戚光.乳腺麦默通手术围术期出血情况分析[J].山东医学高等专科学校学报,2010,32(5):357-359.
[6] SCHAEFER F K,ORDER B M,ECKMANN-SCHOLZ C,et al.Interventional bleeding,hematoma and scar-formation after vacuum-biopsy under stereotactic guidance:Mammotome(?)-system 11 g/8 g vs.ATEC(?)-system 12 g/9 g[J].Eur J Radiol,2012 ,81(5):739-745.
[7] 石光,庞建新,孔焕育,等.尖吻蝮蛇血凝酶药效评价及其作用机制[J].中国新药杂志,2010,19(18):1706-1709.
[8] 于明帅,张科.尖吻蝮蛇血凝酶临床止血作用及安全性研究进展[J].四川医学,2015,36(1):106-108.
[9] 谢奕丹,吴晓玲,李娟娟,等.尖吻蝮蛇血凝酶不同用法用量在乳腺良性肿块麦默通围手术期应用的对比研究[J].广东药科大学学报,2017,33(3):393-397.
[10] 钟秀娟,扶玲,高燕灵,等.我院2014年围术期血凝酶类药物使用分析[J].中国药房,2015,26(23):3195-3197.
[11] 卢珊珊,张峻.尖吻蝮蛇血凝酶临床不合理用药分析[J].药品评价,2014,11(8):28-29.
[12] 徐小燕,李刚,陈集志,等.临床药师干预对外科血凝酶类药物应用的影响分析[J].中国药师,2013,16(4):596-598.
[13] 雷蕾,徐久东,冯国斌,等.麦默通乳腺微创手术术中、术后出血的原因分析及防治[J].西南军医,2012,14(5):702-704.
[14] 石鹤坤,李小玲,林小凤,等.尖吻蝮蛇血凝酶用于手术创口止血效果的Meta分析[J].药物流行病学杂志,2015,24(5):274-278.
[15] 郭娜,韩晟,管晓东,等.神经外科手术应用尖吻蝮蛇血凝酶的经济性研究[J].中国药房,2016,27(2):163-165.
[16] 罗彬,杨健.尖吻蝮蛇血凝酶在腹部手术中的应用研究[J].中国医药指南,2015,13(3):19-20.
[17] 谢丹,杨海燕,黄梅,等.麦默通乳腺微创术后血肿形成的预防[J].广西医学,2007,29(5):705.
[18] 卢振群,李明,徐红.超声引导下乳腺肿物微创旋切术的应用进展[J].中华灾害救援医学,2014,2(4):227-231.
[19] DING B,CHEN D,LI X,et al.Meta analysis of efficacy and safety between mammotome vacuum-assisted breast biopsy and open excision for benign breast tumor[J].Gland Surg,2013,2(2):69-79.
[20] 白雪,杜峻峰,苑树俊,等.手术后应用尖吻蝮蛇血凝酶止血的安全性评价[J].中国临床药理学杂志,2011,27(4):255-258.