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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

[Pharmacoeconomic evaluation of Shaoma Zhijing Granules in treatment of tic disorders in children].

作者信息

Wu Xue, Wan Chu-Chuan, Zhang Yu-Xuan, Liao Xing, Wang Yong-Yan

机构信息

Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences Beijing 100700, China.

the Research Center of National Drug Policy & Ecosystem, China Pharmaceutical University Nanjing 211198, China.

出版信息

Zhongguo Zhong Yao Za Zhi. 2024 Aug;49(15):4238-4248. doi: 10.19540/j.cnki.cjcmm.20240510.502.

Abstract

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.

摘要

本研究对芍麻止痉颗粒治疗儿童抽动障碍(TD)进行了药物经济学评价。首先,从卫生保健系统的角度,采用成本-效果分析方法,评价芍麻止痉颗粒与菖麻熄风片、九味熄风颗粒治疗儿童TD的经济效率。然后,通过网状Meta分析计算不同治疗方案的总体疗效,并结合各方案的总成本,计算增量成本-效果比(ICER)。最后,进行敏感性分析以验证研究结果的稳定性和结论的可信度。本研究纳入17篇文献,其中治疗儿童TD的中成药文献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),中成药联合传统西药文献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)。在中成药组中,芍麻止痉颗粒治疗TD的总成本为4410.00元,临床总有效率为77.53%;九味熄风颗粒治疗TD的总成本为5192.70元,临床总有效率为82.13%。九味熄风颗粒对比芍麻止痉颗粒的ICER为169.95,高于支付意愿(WTP,效率提高1%的成本为85.70元)。因此,九味熄风颗粒相对于芍麻止痉颗粒没有成本-效果优势。菖麻熄风片治疗TD的总成本为1282.50元,临床总有效率为80.60%。菖麻熄风片的总成本低于芍麻止痉颗粒,临床总有效率高于芍麻止痉颗粒。总体而言,芍麻止痉颗粒没有成本-效果优势。在中成药联合传统西药组中,芍麻止痉颗粒联合传统西药治疗TD的总成本为6768.52/6778.48元,临床总有效率为96.18%。九味熄风颗粒联合传统西药治疗TD的总成本为6522.56元,临床总有效率为88.30%。芍麻止痉颗粒联合传统西药对比九味熄风颗粒联合传统西药的ICER为31.20,低于WTP。因此,芍麻止痉颗粒联合传统西药相对于九味熄风颗粒联合传统西药具有成本-效果优势。菖麻熄风片联合传统西药治疗TD的总成本为1706.12元,临床总有效率为95.39%。芍麻止痉颗粒联合传统西药对比菖麻熄风片联合传统西药的ICER为6334.06,高于WTP。因此,虽然芍麻止痉颗粒联合传统西药相对于菖麻熄风片联合传统西药临床总有效率更高,但不具有成本-效果优势。总体而言,对于不同用药方案(中成药单药治疗或联合传统西药),芍麻止痉颗粒和九味熄风颗粒均具有成本-效果优势,但与菖麻熄风片相比,两者均不具有成本-效果优势。对于中成药联合传统西药,芍麻止痉颗粒联合传统西药治疗儿童TD的临床总有效率最高。

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