不同方案药物治疗泌尿系统感染的经济学探析

目的对不同药物治疗方案在泌尿系统感染治疗中的经济学价值进行评价分析。方法抽取我院收治的泌尿系统感染患者168例,将其按照治疗方法分成甲、乙、丙三组,甲组患者采取左氧氟沙星片联合通淋颗粒进行治疗,乙组患者采取单纯左氧氟沙星片进行治疗,丙组患者采取头孢特仑新戊酯片进行治疗,对比三组患者的临床疗效和经济成本。结果甲乙丙三种方案的成本-效果比值以丙组最高(P<0.05),甲组最低(P<0.05)。结论甲组治疗方案采取中西医结合方式进行治疗,疗效显著,经济成本较低,为治疗最佳方案,值得关注。     

拉米夫定联合阿德福韦酯治疗乙型肝炎抗病毒初治症的临床疗效

目的探讨拉米夫定联合阿德福韦酯治疗乙型肝炎抗病毒初治症的临床疗效。方法选取120例乙型肝炎抗病毒初治症患者,将其随机分为3组,A组患者给予拉米夫定治疗,B组患者给予阿德福韦酯治疗,C组患者给予拉米夫定联合阿德福韦酯治疗,治疗48周。治疗后分别于第12、24、48周观察各组患者乙型肝炎病毒脱氧核糖核酸（HBV-DNA）转阴率、乙型肝炎e抗原（HBe Ag）转阴率、血清丙氨酸转氨酶（ALT）复常率、HBe Ag/抗-HBe血清转换率及不良反应发生情况。结果治疗12、24、48周后,C组患者的HBV-DNA转阴率、HBe Ag转阴率、血清ALT复常率、HBe Ag/抗-HBe血清转换率均明显高于A组和B组,差异有统计学意义（P〈0.05）,3组均未出现不良反应,无1例停药,患者耐受性均良好。结论拉米夫定联合阿德福韦酯治疗乙型肝炎抗病毒初治症临床疗效优于单独使用拉米夫定或阿德福韦酯治疗,安全性好。     

阿德福韦酯联合拉米夫定在乙型肝炎肝硬化患者治疗中的效果分析

目的探讨阿德福韦酯联合拉米夫定治疗乙型肝炎肝硬化的临床效果。方法选取乙型肝炎肝硬化患者130例,随机分成两组,在一般治疗的基础上,对照组采取阿德福韦酯治疗;观察组采用阿德福韦酯联合拉米夫定治疗。观察并比较两组患者肝、肾功能、血清HBV-DNA阴转率、HBeAg转阴率、肝脏Child-pugh评分与药物不良反应。结果治疗后观察组的Child-Pugh评分、丙氨酸氨基转移酶、天冬氨酸氨基转移酶、层粘连蛋白、透明质酸较对照组下降更明显,P<0.05,差异有统计学意义;观察组的血清HBV-DNA阴转率、HbeAg阴转率和HbeAg/抗-HbeAb血清转换率显著高于对照组,P<0.05,结果有统计学意义。结论阿德福韦酯联合拉米夫定治疗乙型肝炎肝硬化可明显改善患者肝功能,降低耐药发生比例,减缓肝纤维化的速度,不良反应少,有效降低了肝癌发生率及病死率。     

恩替卡韦对代偿期乙型病毒性肝炎肝硬化患者血清甲状腺激素的影响

目的探讨恩替卡韦治疗对代偿期乙型病毒性肝炎肝硬化患者血清甲状腺激素的影响。方法选取2014年7月至2017年6月辽宁省盘锦市传染病医院收治的50例代偿期乙型病毒性肝炎肝硬化患者作为研究资料,所有患者HBV-DNA均为阳性,采用恩替卡韦对患者进行治疗,设为观察组,采集患者治疗前后血清甲状腺激素T_3、T_4、FT_3、FT_4以及TSH水平进行比较,并随机与同期收集相同数量健康人资料的相同指标进行比对,分析恩替卡韦治疗代偿期乙型病毒性肝炎肝硬化患者过程中血清甲状腺激素的变化效果。结果治疗前,观察组患者血清T_3、T_4、FT_3以及FT_4水平较健康组相同指标更低,TSH水平较健康组更高,差异有统计学意义(P<0.05);治疗后,观察组HBV-DNA转阴患者的血清T_3、T_4、FT_3、FT_4、TSH水平较治疗前有明显变化(P<0.05),HBV-DNA未转阴患者各项指标较治疗前无明显改善(P>0.05);观察组HBV-DNA转阴与未转阴患者经治疗后,各项肝功能指标与治疗前比较差异有统计学意义(P<0.05),HBV-DNA转阴患者AST、ALB、PT三项指标与HBV-DNA未转阴患者比较,差异有统计学意义(P<0.05)。结论恩替卡韦治疗代偿期乙型病毒性肝炎肝硬化患者可有效恢复血清甲状腺激素水平,促进HBV-DNA转阴,并恢复患者肝功能指标,治疗疗效良好。     

米索前列醇应用于产后出血的药理分析及疗效

目的分析研究米索前列醇治疗产后出血的疗效。方法随机抽选我院收治的120例产妇,均分为三组,甲组给予缩宫素静脉推注治疗,乙组在甲组基础上使用米索前列醇直肠给药,丙组在甲组基础上使用米索前列醇舌下含服,分别记录分析三组产后出血情况。结果三组治疗后,均未出现出血情况,乙、丙两组的出血量明显低于甲组,比较有差异,P<0.05有统计学意义;乙、丙两组出血量比较无明显差异,P>0.05,无统计学意义。结论给予米索前列醇患者治疗,可有效减少产后出血,效果显著,安全可靠。     

拉米夫定联合阿德福韦酯治疗慢性乙型肝炎的临床疗效

目的观察拉米夫定联合阿德福韦酯治疗慢性乙型肝炎的临床疗效。方法选取我院2011年4月至2013年4月收治的68例慢性乙型肝炎患者作为研究对象,随机分为两组,对照组单用拉米夫定治疗,观察组应用拉米夫定联合阿德福韦酯治疗,比较两组患者的治疗效果。结果治疗6个月时,两组患者的各项指标比较均不具有显著性差异,P>0.05;治疗12个月时,两组患者的HBeAg转阴率及HBeAg血清学转换比较,差异无统计学意义(P>0.05);但观察组的HBV-DNA拷贝量(<500copies/ml、<1000copies/ml)、ALT复常率,均显著高于对照组,P<0.05,差异有统计学意义。结论在慢性乙型肝炎的临床治疗中,与单用拉米夫定相比,拉米夫定联合阿德福韦酯治疗效果更为显著,且无不良反应,具有重要的推广应用价值。     

国产阿德福韦酯治疗活动性失代偿肝硬化的临床分析

目的研究并探讨国产阿德福韦酯对活动性失代偿肝硬化的临床治疗效果。方法选取100例活动性失代偿肝硬化患者,对其进行分组处理,对照组运用传统的治疗方式进行治疗,即保肝、对症以及血制品支持等;治疗组在对照组治疗基础上外加国产阿德福韦酯来对其进行治疗。1疗程之后,将两组患者的临床疗效进行对比分析。结果治疗组患者无论在临床不良反应的发生率及临床疗效方面均明显优于对照组,治疗组总有效率达96%,与对照组患者相比,差异具有显著性(P<0.05)。结论国产阿德福韦酯是临床中治疗活动性失代偿肝硬化的主要手段,且安全、有效,值得推广应用。     

米索前列醇不同给药途径预防产后出血的临床疗效

目的探讨米索前列醇不同给药途径预防产后出血的临床疗效。方法选取240例产妇,随机分成甲、乙、丙3组,各80例。甲组产妇采用直肠给药,乙组产妇采用阴道给药,丙组产妇采用口服给药,并比较预防产后出血疗效。结果 3组产妇不同给药途径的产后出血量及第3产程时间相比,差异无统计学意义(P>0.05);甲组不良反应发生率明显高于其他两组,差异有统计学意义(P<0.05)。结论米索前列醇在减少产后出血和缩短第3产程有一定的效果,但不同给药途径与预防产后出血的临床效果关系不大。     

核苷酸类似物治疗乙肝疗效评价

目的 评价核苷酸类似物阿德福韦酯治疗乙肝的疗效.方法 将慢性乙肝初治患者70例,分为对照组与治疗组,分别使用干扰素IFNa-2b与核苷酸类似物阿德福韦酯治疗,比较两组的疗效及治疗成本.结果 治疗组6个月时的丙氨酸转氨酶（ALT）复常率为85.7％显著高于对照组的34.3％（P＜0.05）,HBeAg转阴率为31.4％与对照组的28.6％比较无统计学意义（P＞0.05）.结论 核苷酸类似物阿德福韦酯治疗乙肝疗效好,不良反应少,患者经济负担小,值得临床推广.     

肾衰竭患者的临床治疗

目的探讨肾衰竭患者的临床治疗方法及效果。方法将我院接收的肾衰竭46例患者,随机分为甲组和乙组。对两组患者采用不同方法治疗,对两组患者的疗效和并发症状况进行比较分析。结果甲组治疗总有效率为82.6%,并发症的发生率为21.7%,乙组治疗总有效率为56.5%,并发症的发生率为60.9%,差异均有统计学意义(P<0.05)。结论血液透析对肾衰竭患者的临床治疗效果较好,治疗总有效率较高,并发症较少,是一种有效、可靠的治疗方式。     

4种给药方案治疗滴虫性阴道炎患者的药物经济学评价

目的探讨4种给药方案治疗滴虫性阴道炎患者的成本-效果。方法选取2019年1月至2020年5月于沈阳市妇婴医院妇产科门诊诊治的滴虫性阴道炎患者115例作为研究对象,依据随机数字表法分为4组,包括A组(n=30,保妇康栓+奥硝唑片治疗)、B组(n=27,双唑泰栓+奥硝唑片治疗)、C组(n=29,甲硝唑栓+奥硝唑片治疗)、D组(n=29,奥硝唑片治疗),比较4组患者临床疗效、不良反应发生情况、成本-效果,并进行敏感性分析。结果 A组治疗有效率为90.00%(27/30),B组治疗有效率为92.59%(25/27),C组治疗有效率为93.10%(27/29),D组治疗有效率为86.21%(25/29)。A组成本-效果比为0.74,B组成本-效果比为0.52,C组成本-效果比为0.45,D组成本-效果比为0.45;以D组为参照,其中A组增量成本-效果比为12.96,B组增量成本-效果比为4.69,C组增量成本-效果比为3.56。结论甲硝唑栓+奥硝唑片治疗滴虫性阴道炎效果显著,且成本较低,不良反应少。     

乙型肝炎纤维化的中医药疗法

目的探讨乙型肝炎纤维化的中医药疗法。方法选取2009年5月至2013年12月我院门诊收治的90例慢性乙型肝炎患者,将其分为两组,两组患者均采用常规治疗,中西医结合组在此基础上采用抗纤维化汤治疗,对比两组患者治疗效果。结果中西医结合组患者总有效率为95.0%,西医组患者总有效率为66.7%,两组比较差异有统计学意义（P〈0.05）。结论采用抗纤维化汤结合基础治疗乙型肝炎纤维化患者,有效率高,效果良好,可明显改善患者的生存质量。     

Economic burden of hepatitis C-associated diseases: Europe,Asia Pacific,and the Americas

Abstract

Background:

Globally, hepatitis C virus (HCV) infects ～3% of the population. The objective of this study was to review published work and determine the direct medical costs for diseases associated with HCV infection globally, with the exception of the US.

Methods:

A systematic literature search was conducted to identify studies reporting the costs of hepatitis C sequelae between January 1990 and January 2011. Over 400 references were identified, of which 45 were pertinent. The costs were compiled, converted to US dollars, and adjusted to 2010 costs using the medical component of the consumer price index.

Results:

The median cost of liver transplants was estimated at $139,070 ($15,430–$443,700), refractory ascites at $16,740 ($8990–$35,940), hepatocellular carcinoma (HCC) at $15,310 ($3370–$84,710), decompensated cirrhosis at $14,660 ($3810–$48,360), variceal hemorrhage at $12,190 ($3550–$46,120), hepatic encephalopathy at $9180 ($5370–$50,120), diuretic sensitive ascites at $3400 ($1320–$7470), compensated cirrhosis at $820 ($50–$2890), and chronic hepatitis C at $280 ($90–$1860). The variation among studies was mainly due to the methodology used to assess cost, local cost and government reimbursement, and country-specific treatment protocols.

Limitations:

All costs were adjusted to 2010 US dollars using the US medical component of the consumer price index (CPI) which may not reflect the change in medical costs in other countries. In addition, the costs, in the local currency were converted to US dollars in the year of the study. However, medical expenses may not vary with exchange rate, leading to artificial variations. Finally, there was no assessment of the quality of individual studies, which resulted in the same weighting to all studies.

Conclusions:

Hepatitis C imposes a high economic burden globally. Knowing the burden of HCV sequelae is useful for policy decisions as well as serving as a basis for determining the value of HCV screening and treatment.     

2009年广水市高中生乙肝表面抗原检测结果分析

目的了解2009年广水市高中生乙肝病毒(HBV)感染情况,为制定乙肝防治对策,保护学生身体健康提供科学依据。方法 HBsAg采用酶联免疫吸附法(ELISA)对广水市所辖区域内七所高中生共计8486名进行检测,并对检测结果进行统计分析。结果检出HBsAg阳性者共671例,阳性率7.91%。其中男生HBsAg阳性427例,阳性率5.03%;女生HBsAg阳性244例,阳性率为2.88%;二者差异有统计学意义。结论男生HBV感染率显著高于女生,可能与男生没有女生讲究卫生,生活用品交叉使用,尤其与交叉使用牙刷和剃须刀有关。为有效降低高中生HBV感染率,可加大对高中生健康教育宣传力度、对高中学生定期进行健康体检、并对HBsAg阴性者进行乙肝疫苗的接种工作,提高免疫覆盖率和人群免疫水平。     

Cost-effectiveness of currently recommended direct-acting antiviral treatments in patients infected with genotypes 1 or 4 hepatitis C virus in the US

Objective: This study compared the cost-effectiveness of direct-acting antiviral therapies currently recommended for treating genotypes (GT) 1 and 4 chronic hepatitis C (CHC) patients in the US.

Methods: A cost-effectiveness analysis of treatments for CHC from a US payer’s perspective over a lifelong time horizon was performed. A Markov model based on the natural history of CHC was used for a population that included treatment-naïve and -experienced patients. Treatment alternatives considered for GT1 included ombitasvir/paritaprevir/ritonavir?+?dasabuvir?±?ribavirin (3D?±?R), sofosbuvir?+?ledipasvir (SOF/LDV), sofosbuvir?+?simeprevir (SOF?+?SMV), simeprevir?+?pegylated interferon/ribavirin (SMV?+?PR) and no treatment (NT). For GT4 treatments, ombitasvir/paritaprevir/ritonavir?+?ribavirin (2D?+?R), SOF/LDV and NT were compared. Transition probabilities, utilities and costs were obtained from published literature. Outcomes included rates of compensated cirrhosis (CC), decompensated cirrhosis (DCC), hepatocellular carcinoma (HCC) and liver-related death (LrD), total costs, life-years and quality-adjusted life-years (QALYs). Costs and QALYs were used to calculate incremental cost-effectiveness ratios.

Results: In GT1 patients, 3D?±?R and SOF-containing regimens have similar long-term outcomes; 3D?±?R had the lowest lifetime risks of all liver disease outcomes: CC =?30.2%, DCC = 5.0?%, HCC = 6.8%, LT =?1.9% and LrD =?9.2%. In GT1 patients, 3D?±?R had the lowest cost and the highest QALYs. As a result, 3D?±?R dominated these treatment options. In GT4 patients, 2D?+?R had lower rates of liver morbidity and mortality, lower cost and more QALYs than SOF/LDV and NT.

Limitations: While the results are based on input values, which were obtained from a variety of heterogeneous sources—including clinical trials, the findings were robust across a plausible range of input values, as demonstrated in probabilistic sensitivity analyses.

Conclusions: Among currently recommended treatments for GT1 and GT4 in the US, 3D?±?R (for GT1) and 2D?+?R (for GT4) have a favorable cost-effectiveness profile.     

红光治疗仪联合甲钴胺治疗中老年糖尿病周围神经病变患者的临床疗效

目的探讨红光治疗仪联合甲钴胺治疗中老年糖尿病周围神经病变(DPN)患者的临床疗效。方法选取2018年1—12月于沈阳经济技术开发区人民医院内分泌科治疗的中老年DPN患者160例作为研究对象,按照治疗方法不同分为单纯红光治疗仪治疗组(A组)、甲钴胺治疗组(B组)、红光治疗仪联合甲钴胺治疗组(C组)、对照组(D组),每组40例。比较两组患者空腹血糖(FPG)、餐后2 h血糖(2hPBG)、超氧化物歧化酶(SOD)、震动感觉阈值(VPT)、多伦多临床评分系统(TCSS)评分、治疗减分率。结果治疗后,C组的FPG、2hPBG、VPT水平均明显低于其他3组,SOD明显高于其他3组(P<0.05);B组的FPG、2hPBG水平均明显低于D组、A组(P<0.05);A组的FPG、2hPBG水平均明显低于D组(P<0.05)。治疗后与A、B、D 3组比较,C组TCSS评分明显降低(P<0.05);A组与B组TCSS评分比较差异无统计学意义(P>0.05),A组与B组TCSS评分均明显低于D组(P<0.05)。治疗减分率A组为17.48%,B组为18.64%,C组为31.24%,D组为8.37%,C组治疗减分率明显高于其他3组(P<0.05)。结论运用红光治疗仪联合甲钴胺治疗中老年DPN疗效显著,与单纯红光治疗仪、甲钴胺治疗比较优势明显,可显著改善DPN患者的临床症状。     

莫西沙星注射液与左氧氟沙星注射液随机对照治疗社区获得性肺炎药物经济学评价

目的评价莫西沙星注射液与左氧氟沙星注射液治疗社区获得性肺炎安全性﹑有效性并对两组的医疗费用进行药物经济学评价。方法采用区组随机、开放、平行对照设计方法;各种社区获得性肺炎符合方案集（PP）分析人群73例,将其随机分为两组,A组37例采用莫西沙星注射液400mg,qdivgtt;B组36例采用左氧氟沙星注射液200mg,bidivgtt。运用药物经济学最小成本分析法、成本-效果分析法推算每例治疗成本并进行分析评价。结果两组临床痊愈率和总有效率分别为64.9%、89.2%和63.9%、88.9%,不良反应发生率分别为10.9%和8.7%。治愈每例患者所需药品的最小成本（5386.0±1795.4）元和（2182.2±727.4）元;以临床总有效率计C/E分别为（58.9±19.6）和（35.4±11.8）;ΔC/ΔE为7004。结论虽然莫西沙星疗效优于左氧氟沙星,但根据最小成本法和成本-效果分析表明,左氧氟沙星更具成本-效果优势。     

Cost-effectiveness of direct-acting antiviral regimen ombitasvir/paritaprevir/ritonavir in treatment-naïve and treatment-experienced patients infected with chronic hepatitis C virus genotype 1b in Japan

Objective: This study compared the cost-effectiveness of chronic hepatitis C virus (HCV) genotype 1b (GT1b) therapy ombitasvir/paritaprevir/ritonavir (OBV/PTV/r) vs daclatasvir?+?asunaprevir (DCV/ASV) and no treatment in patients without cirrhosis. Cost-effectiveness analyses (CEAs) that compared OBV/PTV/r against DCV/ASV and sofosbuvir/ledipasvir (SOF/LDV) in Y93H mutation-negative, GT1b patients with and without cirrhosis were also included.

Methods: A health state transition model was developed to capture the natural history of HCV. A CEA over a lifetime horizon was performed from the perspective of the public healthcare payer in Japan. Costs, health utilities, and rates of disease progression were derived from published studies. Sustained virologic response (SVR) rates of OBV/PTV/r and DCV/ASV were extracted from Japanese clinical trials. Analyses were performed for treatment-naïve and -experienced patients. Alternative scenarios and input parameter uncertainty on the results were tested.

Results: OBV/PTV/r exhibited superior clinical outcomes vs comparators. For OBV/PTV/r, DCV/ASV, and no treatment, the lifetime risk of decompensated cirrhosis in treatment-naïve patients without cirrhosis was 0.4%, 1.4%, and 9.2%, and hepatocellular carcinoma was 6.5%, 11.4%, and 49.9%, respectively. Quality-adjusted life years (QALYs) were higher in treatment-naïve and -experienced patients without cirrhosis treated with OBV/PTV/r (16.41 and 16.22) vs DCV/ASV (15.83 and 15.66) or no treatment (11.34 and 11.23). In treatment-naïve and -experienced patients without cirrhosis, the incremental cost-effectiveness ratios (ICERs) of OBV/PTV/r vs DCV/ASV were JPY 1,684,751/QALY and JPY 1,836,596/QALY, respectively; OBV/PTV/r was dominant compared with no treatment. In scenario analysis, including GT1b patients with and without cirrhosis who were Y93H mutation-negative, the ICER of OBV/PTV/r vs DCV/ASV was below the Japanese willingness-to-pay threshold of JPY 5 million/QALY, while the ICER of SOF/LDV vs OBV/PTV/r was above this threshold; thus, OBV/PTV/r was cost-effective.

Conclusion: OBV/PTV/r appears to be a cost-effective treatment for chronic HCV GT1b infection against DCV/ASV. OBV/PTV/r dominates no treatment in patients without cirrhosis.     

Public health impact of comprehensive hepatitis C screening and treatment in the French baby-boomer population

Objective: To estimate the public health impact of comprehensive hepatitis C virus (HCV) screening and access to all-oral, interferon (IFN)-free direct-acting antivirals (DAAs) in the French baby-boomer population (1945–1965 birth cohorts).

Methods: A sequential, multi-cohort, health-state transition model was developed to assess the impact of different hepatitis C screening and treatment strategies on clinical and economic outcomes in the 1945–1965 birth cohorts. Patients newly-diagnosed with chronic HCV were projected each year from 2016 to 2036 under three screening scenarios (70% [low], 75% [intermediate], and 80% [high] HCV awareness in 2036). Healthcare costs and clinical outcomes (number of liver-related deaths, quality-adjusted life-years [QALYs], life-years [LYs] spent in sustained virologic response [SVR] or with decompensated cirrhosis, hepatocellular carcinoma, or liver transplant) were compared among five treatment strategies (no antiviral therapy; IFN?+?ribavirin?+?protease inhibitor for fibrosis stages F2–F4, IFN-based DAAs for stages F2–F4, IFN-free DAAs for stages F2–F4, and IFN-free DAAs for stages F0–F4).

Results: Diagnosis of HCV genotype 1 was projected for 4,953, 6,600, and 8,368 individuals in the low, intermediate, and high screening scenarios, respectively. In the intermediate scenario, IFN-free DAAs for stages F0–F4 had a favorable cost-effectiveness profile vs IFN-based or IFN-free treatment strategies for F2–F4 and offered the greatest return on investment (0.899 LYs gained in SVR and 0.933 QALYs per €10,000 invested).

Conclusion: Comprehensive HCV screening and access to all-oral, IFN-free DAAs is a cost-effective strategy that could help diminish the upcoming burden of HCV in the French baby-boomer population.