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芍麻止痉颗粒治疗儿童抽动障碍的药物经济学评价

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该研究旨在开展芍麻止痉颗粒治疗儿童抽动障碍(TD)的药物经济学评价。首先,基于卫生体系视角,使用成本-效果分析评价芍麻止痉颗粒对比菖麻熄风片、九味熄风颗粒治疗儿童TD的经济性。然后,通过网状Meta分析计算不同方案的总有效率,结合方案总成本,计算增量成本-效果比(ICER)。最后,进行敏感性分析,验证研究结果的稳定性和结论的可信度。共纳入17篇文献,包括单用中成药治疗儿童TD 9篇(芍麻止痉颗粒3篇,九味熄风颗粒2篇,菖麻熄风片4篇),中成药联合常规西药治疗儿童TD 8篇(芍麻止痉颗粒3篇,九味熄风颗粒2篇,菖麻熄风片3篇)。在单用中成药的试验组中,芍麻止痉颗粒治疗TD总成本4 410。00元,临床总有效率77。53%;九味熄风颗粒治疗TD总成本5 192。70元,临床总有效率82。13%;九味熄风颗粒vs芍麻止痉颗粒的ICER为169。95,高于意愿支付值(WTP,每增加1%有效率的成本为85。70元),因此九味熄风颗粒vs芍麻止痉颗粒不具有成本-效果优势。菖麻熄风片治疗TD总成本1 282。50元,临床总有效率80。60%;菖麻熄风片vs芍麻止痉颗粒总成本更低,临床总有效率更高,相对来说芍麻止痉颗粒不具有成本-效果优势。在中成药+常规西药的试验组中,芍麻止痉颗粒+常规西药治疗TD总成本6 768。52/6 778。48元,临床总有效率96。18%;九味熄风颗粒+常规西药治疗TD总成本6 522。56元,临床总有效率88。30%;芍麻止痉颗粒+常规西药vs九味熄风颗粒+常规西药的ICER为31。20,低于WTP,因此芍麻止痉颗粒+常规西药vs九味熄风颗粒+常规西药具有成本-效果优势。菖麻熄风片+常规西药治疗TD总成本1 706。12元,临床总有效率95。39%,芍麻止痉颗粒+常规西药vs菖麻熄风片+常规西药的ICER为6 334。06,高于WTP,因此芍麻止痉颗粒+常规西药vs菖麻熄风片+常规西药治疗尽管临床总有效率更高,但不具有成本-效果优势。综上,针对不同用药方案(中成药/中成药+常规西药),芍麻止痉颗粒vs九味熄风颗粒均具有成本-效果优势,对比菖麻熄风片均不具有成本-效果优势。对于中成药联合常规西药,芍麻止痉颗粒+常规西药治疗儿童TD的临床总有效率最高。
Pharmacoeconomic evaluation of Shaoma Zhijing Granules in treatment of tic disorders in children
This study conducted a pharmacoeconomic evaluation of Shaoma Zhijing Granules in the treatment of tic disorder(TD)in children.Firstly,from the perspective of the healthcare system,cost-effectiveness analysis was used to evaluate the economic efficiency of Shaoma Zhijing Granules compared with Changma Xifeng Tablets and Jiuwei Xifeng Granules in the treatment of TD in children.Then,through network Meta-analysis,the overall effectiveness of different regimens was calculated,combined with the total cost of the regimens,to calculate the incremental cost-effectiveness ratio(ICER).Finally,sensitivity analysis was performed to verify the stability of the study results and the credibility of the conclusions.This study included 17 articles,including 9 articles on Chinese patent medicines(3 on Shaoma Zhijing Granules,2 on Jiuwei Xifeng Granules,and 4 on Changma Xifeng Tablets),for the treatment of TD in children,and 8 articles on Chinese patent medicines combined with conventional western medicines(3 on Shaoma Zhijing Granules,2 on Jiuwei Xifeng Granules,and 3 on Changma Xifeng Tablets).In the Chinese patent medicine group,the total cost of Shaoma Zhijing Granules for treating TD was CNY 4 410.00,with clinical total effective rate of 77.53%;the total cost of Jiuwei Xifeng Granules for treating TD was CNY 5 192.70,with clinical total effective rate of 82.13%.The ICER of Jiuwei Xifeng Granules vs Shaoma Zhijing Granules was 169.95,higher than the willingness-to-pay(WTP,cost of increasing efficiency by 1%is CNY 85.70).Therefore,Jiuwei Xifeng Granules did not have a cost-effectiveness advantage over Shaoma Zhijing Granules.The total cost of Changma Xifeng Tablets for treating TD was CNY 1 282.50,with clinical total effective rate of 80.60%.The total cost of Changma Xifeng Tablets was lower and clinical total effective rate was higher than that of Shaoma Zhijing Granules.Overall,Shaoma Zhijing Granules did not have a cost-effectiveness advantage.In the Chinese patent medicine combined with conventional western medicine group,the total cost of Shaoma Zhijing Granules for treating TD+conventional western medicines was CNY 6 768.52/6 778.48,with clinical total effective rate of 96.18%.The total cost of Jiuwei Xifeng Granules+conventional western medicines for treating TD was CNY 6 522.56,with clinical total effective rate of 88.30%.The ICER of Shaoma Zhijing Granules+conventional western medicines vs Jiuwei Xifeng Granules+conventional western medicines was 31.20,lower than WTP.Therefore,Shaoma Zhijing Granules+conventional western medicines had a cost-effectiveness advantage over Jiuwei Xifeng Granules+conventional western medicines.The total cost of Changma Xifeng Tablets+conventional western medicines for treating TD was CNY 1 706.12,with clinical total effective rate of 95.39%.The ICER of Shaoma Zhijing Granules+conventional western medicines vs Changma Xifeng Tablets+conventional western medicines was 6 334.06,higher than WTP.Therefore,although Shaoma Zhijing Granules+conventional western medicines had higher clinical total effective rate compared with Changma Xifeng Tablets+conventional western medicines,it did not have a cost-effectiveness advantage.Overall,for different medication regimens(Chinese patent medicines monotherapy or in combination with conventional western medicines),Shaoma Zhijing Granules and Jiuwei Xifeng Granules both had a cost-effectiveness advantage,but compared with Changma Xifeng Tablets,neither had a cost-effectiveness advantage.For Chinese patent medicines in combination with conventional western medicines,clinical total effective rate of Shaoma Zhijing Granules in combination with conventional western medicines for the treatment of TD in children was the highest.

Shaoma Zhijing Granulestic disorders in childrenpharmacoeconomic evaluationnetwork Meta-analysissensitivity analysis

吴雪、万楚川、张宇轩、廖星、王永炎

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中国中医科学院中医临床基础医学研究所,北京 100700

中国药科大学国家药物政策与医药产业经济研究中心,江苏南京 211198

芍麻止痉颗粒 儿童抽动障碍 药物经济学评价 网状Meta分析 敏感性分析

国家自然科学基金中国中医科学院科技创新工程项目中国中医科学院科技创新工程项目中国中医药循证医学中心业务研究室主任专项中国中医科学院基本科研业务费优秀青年科技人才(创新类)培养专项

82174239CI2021A00701-3CI2021A055032020YJSZX-2ZZ13-YQ-075

2024

中国中药杂志
中国药学会

中国中药杂志

CSTPCD北大核心
影响因子:1.718
ISSN:1001-5302
年,卷(期):2024.49(15)