Walan A, Eriksson S
Dept. of Medicine, Astra Hässle AB, Mölndal, Sweden.
Scand J Gastroenterol Suppl. 1994;201:91-7. doi: 10.3109/00365529409105373.
The clinical outcome and cost-effectiveness of episodic treatment of duodenal ulcer with omeprazole and ranitidine were evaluated over a 5-year period. The analysis was based on data from published clinical trials comparing healing rates obtained with omeprazole and with ranitidine, as well as on data from the literature on ulcer recurrence and other clinical events. Patients with an active duodenal ulcer were treated until healed or for a maximum of 24 weeks. Maintenance therapy was instituted in patients with ulcers that were very slow to heal and in patients with frequent relapses after cessation of treatment. Patients who experienced frequent relapses while receiving maintenance therapy, and those whose ulcer had not healed after 24 weeks of continuous treatment, were defined as candidates for surgery. A statistical model was set up and a random number generator used to generate a sequence of clinical events, month by month, over a 5-year period for each patient in a large cohort. Episodic treatment with omeprazole was shown to be more effective in avoiding maintenance treatment and surgery when compared with episodic treatment with ranitidine. Patients who received episodic treatment with omeprazole also spent more time in remission from disease. Using current Swedish cost data, it was found that episodic treatment with omeprazole was more cost-effective than episodic treatment with ranitidine.
在5年的时间里，对使用奥美拉唑和雷尼替丁间歇性治疗十二指肠溃疡的临床疗效和成本效益进行了评估。该分析基于已发表的比较使用奥美拉唑和雷尼替丁获得的愈合率的临床试验数据，以及关于溃疡复发和其他临床事件的文献数据。活动性十二指肠溃疡患者接受治疗直至愈合或最长治疗24周。对愈合非常缓慢的溃疡患者以及治疗停止后频繁复发的患者进行维持治疗。在接受维持治疗期间频繁复发的患者，以及连续治疗24周后溃疡仍未愈合的患者，被定义为手术候选者。建立了一个统计模型，并使用随机数生成器逐月生成一大群患者中每位患者在5年期间的临床事件序列。与使用雷尼替丁进行间歇性治疗相比，使用奥美拉唑进行间歇性治疗在避免维持治疗和手术方面更有效。接受奥美拉唑间歇性治疗的患者疾病缓解时间也更长。使用瑞典当前的成本数据发现，使用奥美拉唑进行间歇性治疗比使用雷尼替丁进行间歇性治疗更具成本效益。
