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双氯芬酸加米索前列醇与双氯芬酸单药治疗类风湿性关节炎患者的成本效益比较。

The cost effectiveness of diclofenac plus misoprostol compared with diclofenac monotherapy in patients with rheumatoid arthritis.

作者信息

Al M J, Michel B C, Rutten F F

机构信息

Institute for Medical Technology Assessment, Erasmus University, Rotterdam, The Netherlands.

出版信息

Pharmacoeconomics. 1996 Aug;10(2):141-51. doi: 10.2165/00019053-199610020-00006.

Abstract

The objective of our study was to estimate the cost effectiveness of treatment with a fixed-dose combination of diclofenac and misoprostol compared with diclofenac monotherapy in the prevention of nonsteroidal anti-inflammatory drug (NSAID)-induced ulcers in rheumatoid arthritis (RA) patients. A model was used to incorporate estimates of costs, incidence of ulcers and their complications, death rates and the efficacy of misoprostol. The costs per ulcer-free period gained and costs per additional survivor were calculated. Cost effectiveness was calculated for the treatment of all RA patients, and of risk groups only. All costs were measured in 1995 Netherlands guilders (NLG; exchange rate at the time of the study: NLG1 = $US0.60). The analysis showed that if 100 RA patients receive 3 months of treatment with diclofenac plus misoprostol, instead of diclofenac alone, this will lead to overall additional costs of NLG773, while 0.82 symptomatic ulcers and 0.019 deaths will be prevented. If misoprostol is given only to patients at high risk for NSAID-induced ulcer, cost savings will occur instead of additional costs. Univariate sensitivity analysis showed that the outcomes are sensitive to changes in: (i) the percentage of ulcers treated in the ambulatory setting; (ii) the price difference between diclofenac and the fixed-dose diclofenac-misoprostol combination; (iii) the percentage of ulcers with complications; and (iv) the efficacy of misoprostol. In conclusion, it can be stated that treatment with diclofenac-misoprostol is cost saving in RA patients at high risk for NSAID-induced ulcers. For RA patients in general, the cost-effectiveness of this intervention compares favourably with that of other prophylactic treatments.

摘要

我们研究的目的是评估双氯芬酸与米索前列醇固定剂量联合用药相较于双氯芬酸单药治疗在预防类风湿关节炎(RA)患者非甾体抗炎药(NSAID)诱发溃疡方面的成本效益。采用一个模型纳入成本估算、溃疡及其并发症的发生率、死亡率以及米索前列醇的疗效。计算了每个无溃疡期获得的成本以及每多一名幸存者的成本。计算了所有RA患者以及仅高危组患者治疗的成本效益。所有成本均以1995年荷兰盾(NLG;研究时汇率:NLG1 = 0.60美元)计量。分析表明,如果100名RA患者接受3个月的双氯芬酸加米索前列醇治疗,而非仅用双氯芬酸治疗,这将导致总体额外成本773荷兰盾,同时可预防0.82例有症状的溃疡和0.019例死亡。如果仅对NSAID诱发溃疡的高危患者给予米索前列醇,则会节省成本而非产生额外成本。单因素敏感性分析表明,结果对以下方面的变化敏感:(i)门诊治疗的溃疡百分比;(ii)双氯芬酸与双氯芬酸 - 米索前列醇固定剂量组合之间的价格差异;(iii)有并发症的溃疡百分比;(iv)米索前列醇的疗效。总之,可以说双氯芬酸 - 米索前列醇治疗对于NSAID诱发溃疡的高危RA患者具有成本节约效果。对于一般RA患者,这种干预措施的成本效益与其他预防性治疗相比具有优势。

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