多西他赛联合顺铂行食管癌辅助化疗的近期疗效

目的探讨多西他赛联合顺铂行食管癌辅助治疗的近期疗效。方法选择在我院接受术前多西他赛、顺铂联合辅助治疗的食管癌患者48例作为观察组,另选择同期采用常规手术治疗的食管癌患者48例作为对照组,比较两组手术治疗的总有效率、根治性切除率以及1年之后的生存率。结果观察组总有效率为60.4%,对照组总有效率为47.9%,差异有统计学意义(P<0.05)。观察组的根治性切除率为91.7%(44/48),对照组的根治性切除率为77.1%(37/48),差异有统计学意义(P<0.05)。术后1年生存率观察组明显高于对照组(P<0.05)。结论采用多西他赛联合顺铂行辅助化疗治疗食管癌可明显提高治疗效果及手术切除成功率,同时可以有效提高化疗患者术后1年的生存期,是一种有效治疗方法。     

奥沙利铂联合替吉奥在晚期胃癌治疗中的疗效评价

目的：探讨奥沙利铂联合替吉奥治疗晚期胃癌的疗效。方法选取2010年3月至2013年10月我院收治的晚期胃癌患者112例,将其分为两组,观察组患者给予奥沙利铂联合替吉奥治疗,对照组患者给予替吉奥治疗。结果观察组患者总有效率明显优于对照组,差异有统计学意义（P＜0.05）;随访3～18个月,观察组患者疾病进展时间为（8.4±1.7）个月,生存期平均为（12.5±1.1）个月,均明显优于对照组（P＜0.05）。结论奥沙利铂联合替吉奥治疗晚期胃癌有效提高了患者的生存期,减轻不良反应,是治疗晚期胃癌有效化疗方案的一种。     

利用Bootstrap法进行植物来源抗肿瘤药物用于晚期乳腺癌化疗的药物经济学分析

目的:研究三种植物来源抗肿瘤药物在晚期乳腺癌化疗中的临床作用特点和经济学效果。方法:采用回溯法筛选了69例晚期乳腺癌化疗病例,分成3组,分别为Ⅰ组NP方案(长春瑞滨NVB 顺铂DDP);Ⅱ组PA方案(多西他赛TAXOTERE 多柔比星ADM);Ⅲ组EAP方案(多柔比星ADM 依托泊苷VP-16 顺铂DDP)。运用药物流行病学的疗效比较和药物经济学的成本一效果分析方法进行研究。结果:3组疗效分别为54.54%,58.33%,43.48%。成本效果比分别为384.65元,398.55元,447.86元。结论:NP方案最具药物经济学意义。     

奈达铂对比顺铂用于晚期肺鳞癌化疗的药物经济学评价

目的 从卫生体系角度评价晚期肺鳞癌患者使用奈达铂或顺铂进行化疗的成本-效用,为临床药物选择提供决策依据。方法 根据文献中已发表的多中心Ⅲ期随机对照试验,构建Markov模型,以3%的贴现率对成本和效用值进行贴现,设定研究时限为3年,一周期为3周,采用成本-效用分析评价晚期肺鳞癌患者使用奈达铂对比顺铂的经济性,并对结果进行单因素敏感性分析和概率敏感性分析。结果 以2021年国内3倍人均生产总值（GDP）作为意愿支付（WTP）阈值243000元,奈达铂对比顺铂的增量成本-效果比（ICER）为48606.345元/QALY,明显低于WTP阈值,奈达铂具有经济性。敏感性分析结果显示奈达铂组治疗白细胞减少成本对ICER影响最大。结论 在我国以3倍人均GDP为WTP阈值的前提下,奈达铂用于晚期肺鳞癌化疗对比顺铂具有明显的经济性。     

曲妥珠单抗联合表柔比星与多西他赛治疗晚期乳腺癌的临床效果

目的 探讨曲妥珠单抗联合表柔比星、多西他赛治疗晚期乳腺癌的临床效果。方法 选取2017年1月至2019年1月于宜春市第二人民医院就诊的晚期乳腺癌患者70例作为研究对象,通过随机数字表法分为对照组和观察组,各35例。对照组接受表柔比星、多西他赛治疗,在此基础上观察组联合曲妥珠单抗治疗。比较两组临床疗效、生存情况及不良反应发生率,治疗前后肿瘤标志物[癌抗原125(CA125)、癌抗原15-3(CA15-3)、癌胚抗原（CEA）]及血管内皮生长因子（VEGF）水平。结果 观察组临床获益率（91.43%）与对照组（71.43%）比较明显更高（P<0.05）。观察组无进展生存期和总生存期与对照组比较明显更长（P<0.05）。治疗后两组血清CA125、CA15-3、CEA及VEGF水平较治疗前明显降低,且观察组明显低于对照组,差异有统计学意义（P<0.05）。观察组不良反应发生率（20.00%）与对照组（25.71%）比较差异无统计学意义（P>0.05）。结论 曲妥珠单抗联合表柔比星、多西他赛治疗晚期乳腺癌效果显著,能明显延长患者生存期,降低血清肿瘤标志物及VEGF水平,且...     

艾司西酞普兰治疗中国抑郁焦虑共病患者的系统评价

目的 系统评价艾司西酞普兰治疗中国抑郁焦虑共病患者的有效性及安全性.方法 系统检索CBM、VIP、CMCC、CNKI数据库,检索公开发表的艾司西酞普兰治疗抑郁焦虑共病的随机对照研究（RCT）,对符合纳入标准的文献,运用RevMan 5.0软件对文献数据进行Meta分析,绘制森林图.结果 共纳入8个RCT,共计677例抑郁焦虑共病患者.Meta分析结果显示：①治疗1周后试验组与对照组汉密尔顿抑郁量表（HAMD）评分差异有统计学意义[MD=-3.72,95％CI=（-5.31,-2.14）,P＜0.05];汉密尔顿焦虑量表（HAMA）评分差异无统计学意义[MD-0.42,95％CI=（-2.21,1.36）,P=0.64b治疗疗程结束后的有效率差异无统计学意义[RR=0.99,95％CI=（0.88,1.10）,P=0.80];治愈率差异无统计学意义RR=1.07,95％CI=（0.85,1.36）,P=0.56].②不良反应：试验组不良反应发生率低于对照组,差异有统计学意义[RR=0.53,95％CI=（0.40,0.69）,P＜0.05].结论 艾司西酞普兰治疗中国抑郁焦虑共病患者与对照组疗效相当,但起效快,安全性高.     

吉西他滨联合顺铂治疗晚期非小细胞肺癌的疗效观察

目的探讨吉西他滨联合顺铂方案治疗晚期非小细胞肺癌的疗效。方法随机抽取我院2012年2月至2013年2月收治的84例静脉化疗治疗晚期非小细胞肺癌患者,根据治疗方法的不同分为两组,对照组患者采用吉西他滨治疗,观察组患者则采用吉西他滨+顺铂方案介入联合静脉化疗治疗,针对两组患者治疗效果进行评价,并综合分析吉西他滨+顺铂方案的疗效。结果对照组治疗有效率为71.4%,观察组治疗有效率为97.6%,观察组治疗有效率明显高于对照组,差异有统计学意义(P<0.05);对照组12例(28.6%)发生不良反应,观察组1例(2.4%)发生不良反应,观察组不良反应控制效果明显优于对照组,差异有统计学意义(P<0.05)。结论吉西他滨+顺铂方案介入联合静脉化疗治疗晚期非小细胞肺癌的疗效确切、安全可靠。     

康莱特注射液联合多西他赛治疗老年晚期非小细胞肺癌临床研究

目的观察老年晚期非小细胞肺癌采用康莱特注射液联合多西他赛治疗的临床疗效、生活质量及不良反应。方法将82例老年晚期非小细胞肺癌患者随机分成治疗组(康莱特联合多西他赛)和对照组(单用多西他赛),21天为1个疗程,共观察2个疗程,观察两组近期疗效、生活质量及不良反应。结果治疗组近期有效率为58.54%,对照组有效率为36.59%,两组比较差异有统计学意义(P<0.05);治疗组的生活质量优于对照组,差异具有统计学意义(P<0.05);不良反应中血液学毒性主要表现在白细胞和血小板的降低,主要为Ⅰ~Ⅱ级,治疗组较对照组的发生率降低,具有统计学差异;治疗组胃肠道反应发生率均低于对照组,具有统计学意义;治疗组胃肠道反应发生率均低于对照组,统计学上亦有显著性差异(P<0.05),无明显的肝、肾功能损害现象。结论老年晚期非小细胞肺癌用康莱特注射液联合多西他赛治疗的疗效较好,不仅提高了患者对化疗的耐受性,还提高了患者的生活质量。     

以长春地辛、紫杉醇和足叶已甙为主的化疗方案在食管癌化疗中的评价

目的:评价三种植物来源抗肿瘤药物在食管癌化疗中的经济效益和临床作用特点。方法:采用回溯法筛选了111例食管癌病例,分成3组,分别为Ⅰ组PVB方案(长春地辛VDS 博莱霉素BLM 顺铂DDP);Ⅱ组TD方案(紫杉醇TAXOL 顺铂DDP);Ⅲ组PEF方案(足叶乙甙VP-16 氟尿嘧啶5-FU 顺铂DDP)。运用药物流行学的疗效比较和药物经济学的成本—效果分析方法进行研究。结果:3组疗效分别为55.56%,47.36%,43.24%。成本效果比分别为380.13元,423.45元,379.46元。结论:PVB方案具有较好的药物经济学意义。     

采用EQ-5D评估2型糖尿病患者的生活质量及影响因素研究

目的：采用EuroQol五维调查问卷表（EQ-5D）对2型糖尿病患者健康相关的生活质量进行评价,并分析其主要影响因素,探讨健康状况发展与生活质量下降的关系。方法：采用EQ-5D问卷及访问,对南京大学附属南京鼓楼医院内分泌门诊256例2型糖尿病患者生活质量和健康状况进行研究。结果全体患者EQ-5D分值平均0．790±0．158。理想控制的患者组平均值0．836（0．810～0．861;95％CI）,良好控制和控制差的组的分值分别相当于理想患者的92．2％、84．8％。出现一种或多种并发症的患者分值0．692（0．667～0．717．95％CI）,未出现并发症的患者提高到0．863（0．842～0．883,95％CI）。各种并发症的发生发展与血糖控制情况对生活质量影响程度最强。结论：EQ-5D量表适用于中国2型糖尿病患者健康状况测量,适宜成本-效果分析研究。血糖控制不理想和各并发症的发生发展是患者生活质量下降的主要影响因素。     

血必净注射液治疗重症急性胰腺炎的Meta分析

目的评价血必净注射液对重症急性胰腺炎（SAP）患者的影响,从而了解血必净用于辅助治疗重症急性胰腺炎的临床疗效。方法选择符合纳入标准的随机或临床对照试验（CRT、CCT）文献,对数据进行Meta分析。结果5项研究纳入421例患者,Meta分析显示,血必净＋乌司他丁＋基础治疗组与乌司他丁＋基础治疗组比较,腹痛缓解时间（WMD=-1.86,95%CI：-2.27～-1.45,P=0.00001）、血淀粉酶恢复正常时间（WMD=-1.80,95%CI：-2.68～-0.93,P〈0.0001）、尿淀粉酶恢复正常时间（WMD=-1.96,95%CI：-2.42～-1.50,P〈0.00001）、白细胞计数恢复正常时间（WMD=-2.49,95%CI：-3.56～-1.41,P〈0.00001）以及总有效率（RR=1.16,95%CI：1.07～1.25,P=0.0002）的差异有统计学意义。结论应用血必净的治疗组能明显缩短重症急性胰腺炎患者腹痛缓解时间、血（尿）淀粉酶以及白细胞计数恢复正常时间,且治疗组的总有效率明显高于对照组。     

贝伐珠单抗治疗转移性结直肠癌的效果与成本研究综述

目的综合回顾有关贝伐珠单抗联合化疗治疗效果及不良反应的Meta分析,及联合化疗对比单一化疗的成本效果分析,探讨贝伐珠单抗联合化疗为转移性结直肠癌患者带来的效果及不良反应及成本效果分析,为贝伐珠单抗在治疗的应用提供一定的参考。方法检索Pubmed、中国期刊全文数据库(CNKI)等发表的对比mCRC患者中贝伐珠单抗联合化疗及单一化疗的Meta分析及成本效果分析。综述Meta分析及成本效果分析的结果。结果纳入的6个Meta分析,显示贝伐珠单抗联合化疗较单一化疗显著提高了患者无进展生存时间、中位总生存期,然而使用贝伐珠单抗可能增加高血压、蛋白尿、出血等风险,而对胃穿孔、血栓等并无显著差异。成本效果分析表明,贝伐珠单抗相较于西妥昔单抗在成本上具有优势,效果相差并不非常显著。结论贝伐珠单抗具有较高成本,然而贝伐珠联合化疗能显著提高患者的生存收益,一定程度上增加不良反应,基于中国本土数据的成本效果分析还需进一步开展。     

胃蛋白酶原亚群测定与萎缩性胃炎相关性研究及效价比分析

目的：研究血清中胃蛋白酶原（pepsinogen）亚群（PGⅠ、PGⅡ）含量在健康体检者及胃部疾病患者中的水平,探讨血清中PG亚群测定对萎缩性胃炎及胃癌早期诊断的意义。方法：利用放射免疫法（RIA）测定35例健康体检者、18例胃溃疡患者、30例萎缩性胃炎患者、30例胃癌患者中PGⅠ、PGⅡ及PGⅠ／PGⅡ值的变化,在正常组（健康体检者）与各疾病组之间进行统计学比较,并比较胃蛋白酶原检测与胃镜和（或）病理检查费用的效价比。结果：（1）与正常组相比,消化性溃疡患者PGⅠ、PGⅡ升高,且PGⅡ增高明显,PGⅠ／PGⅡ比值降低;萎缩性胃炎组和胃癌组PGⅠ水平均呈下降趋势,但PGⅡ水平变化不明显,PGⅠ／PGⅡ比值下降。（2）与溃疡组相比,萎缩性胃炎和胃癌患者PGI、PGⅡ及PGⅠ／PGⅡ比值均明显降低。（3）与萎缩性胃炎组相比,胃癌患者PGⅠ、PGⅡ及PGⅠ／PGⅡ比值虽略低于萎缩性胃炎,但差异无统计学意义。（4）PGⅠ≤80ng／mL且PGⅠ／PGⅡ≤5时,检出萎缩性胃炎的特异度和灵敏度分别为94．3％和53．3％。结论：（1）血清PGⅠ和PGⅠ／PGⅡ比值的降低,是萎缩性胃炎及胃癌人群筛查和辅助诊断的一项血清学指标。（2）血清PGⅠ≤80ng／mL且PGⅠ／PGⅡ≤6检测萎缩性胃炎具有较好的特异度和灵敏度。（3）测定血清中PG亚群的方法简单易行,适用于初筛及胃镜检查禁忌者,且与直接行胃镜并取病理检查相比较为经济。     

Cost of adverse events during treatment with everolimus plus exemestane or single-agent chemotherapy in patients with advanced breast cancer in Western Europe

Objective:

Treatment options for recurrent or progressive hormone receptor-positive (HR+) advanced breast cancer include chemotherapy and everolimus plus exemestane (EVE?+?EXE). This study estimates the costs of managing adverse events (AEs) during EVE?+?EXE therapy and single-agent chemotherapy in Western Europe.

Methods:

An economic model was developed to estimate the per patient cost of managing grade 3/4 AEs for patients who were treated with EVE?+?EXE or chemotherapies. AE rates for patients receiving EVE?+?EXE were collected from the phase III BOLERO-2 trial. AE rates for single-agent chemotherapy, capecitabine, docetaxel, or doxorubicin were collected from published clinical trial data. AEs with at least 2% prevalence for any of the treatments were included in the model. A literature search was conducted to obtain costs of managing each AE, which were then averaged across Western European countries (when available). Per patient costs for managing AEs among patients receiving different therapies were reported in 2012 euros (€).

Results:

The EVE?+?EXE combination had the lowest average per patient cost of managing AEs (€730) compared to all chemotherapies during the first year of treatment (doxorubicin: €1230; capecitabine: €1721; docetaxel: €2390). The most costly adverse event among all patients treated with EVE?+?EXE was anemia (on average €152 per patient). The most costly adverse event among all patients treated with capecitabine, docetaxel, or doxorubicin was lymphocytopenia (€861 per patient), neutropenia (€821 per patient), and leukopenia (€382 per patient), respectively.

Conclusions:

The current model estimates that AE management during the treatment of HR+ advanced breast cancer will cost one-half to one-third less for EVE?+?EXE patients than for chemotherapy patients. The consideration of AE costs could have important implications in the context of healthcare spending for advanced breast cancer treatment.     

血必净联合乌司他丁与单用乌司他丁治疗脓毒症的Meta分析

目的：探讨血必净注射液对炎症的影响及治疗脓毒症患者的临床疗效。方法检索各大数据库,查找血必净治疗脓毒症的相关临床试验,并采用RevMan 5.0进行Meta分析。结果共纳入4项随机对照临床试验,治疗组181例患者给予血必净＋乌司他丁＋基础治疗,对照组181例患者给予乌司他丁＋基础治疗。Meta分析结果显示,治疗组患者与对照组患者的肿瘤坏死因子（TNF-α）水平比较,差异无统计学意义（WMD=-5.16,95% CI：-11.0～0.76）;治疗组患者与对照组患者在白细胞介素-6（IL-6）水平（WMD=-57.82,95%CI：-112.12～-3.52）、降钙素原（PCT）水平（WMD=-0.53,95%CI：-0.88～-0.19）、平均住院时间（WMD=-3.63,95%CI：-4.68～-2.58）、平均机械通气时间（WMD=-3.77,95%CI：-4.70～-2.83）比较,差异均有统计学意义。结论应用血必净患者的白细胞介素-6（IL-6）、前降钙素（PCT）水平更低,平均住院时间、平均机械通气时间更短。     

The economic advantages of response in the treatment of advanced breast cancer

Summary

The introduction of a new class of drugs, the taxoids, has dramatically improved the outlook for patients with advanced, metastatic breast cancer. Second-line monotherapy with the most effective taxoid, docetaxel, in patients with anthracycline-resistant metastatic breast cancer, shows an overall response rate up to 55% in this patient population. Increased response rate is associated with improved quality of life for these patients.

We carried out a cost analysis to determine the economic benefits of being in a response state compared with the other health states associated with advanced breast cancer: stable, progressive or terminal disease.

We found that the cost of care for responders is 40% of that for early progressive disease and just over a third of that for late progressive disease. The costs associated with stable disease are only a little less than those for progressive disease, and are more than double the costs for patients who have responded to chemotherapy. The costs during terminal disease are the highest, and are more than nine times those associated with caring for responders.

Our findings confirm other studies which demonstrate that the cost of chemotherapy can be offset against the reduction in costs incurred for patients who remain in healthier states for longer. The key parameter determining the economic efficiency of treatments for advanced breast cancer is response rate.     

吉非替尼与厄洛替尼治疗非小细胞肺癌效果的间接比较

目的系统评价吉非替尼与厄洛替尼治疗非小细胞肺癌的临床效果.方法检索国内外公开发表的关于吉非替尼或厄洛替尼治疗非小细胞肺癌的中英文文献,采用Bucher法对纳入的研究进行间接比较.结果共纳入4项吉非替尼vs标准治疗和3项厄洛替尼vs标准治疗的文献进行间接比较.吉非替尼与厄洛替尼治疗非小细胞肺癌的反应率和疾病控制率的 RR 值分别为0.56（P=0.0536）、0.87（P=0.6745）,中位生存期和中位无发展生存期的 MD 值分别为-0.31（P=0.7718）、-3.93（P=0.1443）.结论尽管间接比较存在一定的局限性,但结果表明吉非替尼与厄洛替尼治疗非小细胞肺癌的效果无显著性差异.     

和胃解毒汤治疗食道癌患者的疗效和安全性

目的探讨和胃解毒汤治疗食道癌患者的疗效以及安全性,为临床治疗食道癌提供新思路。方法选取2019年1月至2020年5月梅州市人民医院收治的食道癌患者62例作为研究对象,按照不同的治疗方案分为对照组(30例)和试验组(32例)。对照组给予调强适形放射治疗加紫杉醇(TXL)联合洛铂(LBP)化疗,即TP化疗方案;试验组在对照组基础上加用和胃解毒汤。比较分析两组患者的治疗效果,并评价两组患者的胃肠道不良反应发生情况。结果试验组治疗有效率及疾病控制率分别为78.13%和87.50%,显著高于对照组的53.33%和66.67%,差异有统计学意义(P<0.05);主要不良反应为胃肠道反应,以恶心呕吐、食欲下降为主,可耐受,其中试验组胃肠道不良反应发生率9.38%,显著低于对照组的30.00%(P<0.05)。结论和胃解毒汤在食道癌患者综合治疗中具有良好的疗效,减轻了不良反应,对治疗食道癌有积极的意义。     

A comparison of the estimated costs of erlotinib,docetaxel and pemetrexed for the second-line treatment of non-small cell lung cancer from the German healthcare perspective

Summary

The estimated costs of second-line therapy with erlotinib versus docetaxel or pemetrexed were analysed in patients with advanced non-small cell lung cancer (NSCLC) assuming the survival benefits delivered by these three drugs are comparable. Direct total costs to the German statutory health insurance system per patient per quarter were compared, including the impact of grade 3/4 side effects. Resource utilisation data came from clinical studies and/or were supplemented on the basis of guidelines/prescribing information. Basic costs per patient per quarter were: erlotinib €8,172; docetaxel €8,055; and pemetrexed €15,870. Including the cost of managing side effects, the total cost per patient per quarter with erlotinib was €8,376 compared with €9,976 for docetaxel and €16,596 for pemetrexed. The main influence on the cost analysis was the management of haematological side effects associated with docetaxel and to a lesser extent pemetrexed. Sensitivity analyses confirmed the robustness of the results. Based on its favourable side-effect profile, erlotinib offers health economic advantages over docetaxel and pemetrexed in relapsed advanced NSCLC in Germany.     

The effect of pharmacogenetic profiling with a clinical decision support tool on healthcare resource utilization and estimated costs in the elderly exposed to polypharmacy

Objective:

To compare healthcare resource utilization (HRU) and clinical decision-making for elderly patients based on cytochrome P450 (CYP) pharmacogenetic testing and the use of a comprehensive medication management clinical decision support tool (CDST), to a cohort of similar non-tested patients.

Methods:

An observational study compared a prospective cohort of patients ≥65 years subjected to pharmacogenetic testing to a propensity score (PS) matched historical cohort of untested patients in a claims database. Patients had a prescribed medication or dose change of at least one of 61 oral drugs or combinations of ≥3 drugs at enrollment. Four-month HRU outcomes examined included hospitalizations, emergency department (ED) and outpatient visits and provider acceptance of test recommendations. Costs were estimated using national data sources.

Results:

There were 205 tested patients PS matched to 820 untested patients. Hospitalization rate was 9.8% in the tested group vs 16.1% in the untested group (RR?=?0.61, 95% CI?=?0.39–0.95, p?=?0.027), ED visit rate was 4.4% in the tested group vs 15.4% in the untested group (RR?=?0.29, 95% CI?=?0.15–0.55, p?=?0.0002) and outpatient visit rate was 71.7% in the tested group vs 36.5% in the untested group (RR?=?1.97, 95% CI?=?1.74–2.23, p?<?0.0001). The rate of overall HRU was 72.2% in the tested group vs 49.0% in the untested group (RR?=?1.47, 95% CI?=?1.32–1.64, p?<?0.0001). Potential cost savings were estimated at $218 (mean) in the tested group. The provider majority (95%) considered the test helpful and 46% followed CDST provided recommendations.

Conclusion:

Patients CYP DNA tested and treated according to the personalized prescribing system had a significant decrease in hospitalizations and emergency department visits, resulting in potential cost savings. Providers had a high satisfaction rate with the clinical utility of the system and followed recommendations when appropriate.