运用成本—效果分析方法对COPD稳定期优选治疗方案的研究

发布时间：2018-10-13 13:01

【摘要】：目的：本研究目的为观察中医药在COPD稳定期的综合作用以及从药物经济学角度评价中医药在COPD稳定期治疗方案的应用价值。方法：本研究选择90例符合标准COPD稳定期患者纳入观察,将其随机分成西医组、中医辨证组及中西结合组各30例,展开为期半年的既定方案治疗(西医组按照西医规范化治疗,中医辨证组给予中医辨证分型治疗,中西结合组在西医规范化治疗基础上合并中医辨证分型治疗),以治疗效果、急性加重住院次数、治疗成本作为主要观察指标,比较各组治疗前后上述各项观察指标的变化情况,观察记录各项数据并进行统计学分析处理,分别计算出各组疗效及治疗成本并进行成本效果分析。成果：本研究结果表明：经过6个月的治疗,三组的总症状积分均较治疗前有改善；其中西医组咳痰、气喘、气短、哮鸣音积分及总症候积分治疗后有改善,经检验有统计学意义(P0.05),咳痰、自汗、易感冒积分治疗后改善不明显(P0.05)；中医辨证组与中西结合组治疗后各项症候积分均较治疗前有改善,经检验有统计学意义(P0.05)；西医组和中西结合组治疗前后总症候积分差值比较有统计学意义(P0.05)。中西结合组急性加重住院次数及住院天数最少,与西医组及中医辨证组比较有统计学意义(P0.05),西医组的平均急性加重住院次数及平均住院天数与中医辨证组比较无统计学意义(P0.05)。对三种治疗方案费用进行分析,中西结合组急性加重住院次数及造成的费用低于西医组和中医辨证组。三组经过半年的治疗,治疗总有效率分别为西医组80%、中医辨证组52%、中西结合组100%；总费用分别为西医组5207元、中医辨证组4365元、中西结合组5603元；三组的成本-效果比分别为西医组65、中医辨证组84、中西结合组56。以中医组的疗效为参照,西医组与中西结合组的增量成本分别为30和26,即每增加1个疗效单位,西医组需要增加费用30元,中西结合组增加费用26元。敏感度分析也证明了结果的可靠性。结论：中西结合组疗效优于中医辨证组和西医组。中西结合组及中医辨证组药物不良反应少于西医组,在咳嗽、自汗、易感冒等症状改善上亦优于西医组。从药物经济学角度分析,中西结合组是三种治疗方案中的最合理方案。
[Abstract]:Objective: to observe the comprehensive role of Chinese medicine in the stable period of COPD and evaluate the application value of Chinese medicine in the treatment of COPD stable period from the point of view of pharmacoeconomics. Methods: 90 patients with stable COPD were randomly divided into western medicine group, TCM syndrome differentiation group and Chinese medicine combined group (30 cases each). To start a half-year plan of treatment (Western medicine group in accordance with western medicine standardized treatment, TCM syndrome differentiation group to give TCM syndrome differentiation treatment, Chinese and Western combination group on the basis of western medicine standardized treatment combined with TCM syndrome differentiation treatment), in order to treat the effect, The times of acute exacerbation of hospitalization and the cost of treatment were used as the main observation indexes. The changes of the above indexes before and after treatment were compared, and the data were recorded and analyzed statistically. The curative effect and treatment cost were calculated and the cost effect was analyzed. Results: the results showed that after 6 months of treatment, the total symptom scores of the three groups were improved compared with those before treatment, and that of the traditional Chinese and western medicine group was improved after the treatment of expectoration, asthma, shortness of breath, wheezing score and total symptom integral. After the test there was statistical significance (P0.05), expectoration, self-sweating, easy to catch cold after treatment did not improve significantly (P0.05); TCM syndrome differentiation group and the combination of Chinese and Western groups after treatment of symptoms and symptoms were improved compared with before treatment, after the test has statistical significance (P0.05); Western medicine group and the combination of Chinese and Western groups before and after treatment of the total symptom score difference was statistically significant (P0.05). The number of acute aggravation hospitalization and hospitalization days were the least in the combination group, and there was statistical significance compared with the Western medicine group and TCM syndrome differentiation group (P0.05), the average number of acute exacerbation hospitalization and average hospitalization days in the Western medicine group were not statistically significant compared with the TCM syndrome differentiation group (P0.05). The cost of three treatment schemes was analyzed. The times of hospitalization and the cost of acute exacerbation in the combination group were lower than those in the western medicine group and traditional Chinese medicine syndrome differentiation group. After half a year's treatment, the total effective rates of the three groups were 80 in western medicine group, 52 in TCM syndrome differentiation group and 100 in Chinese traditional medicine combination group, the total cost was 5207 yuan in western medicine group, 4365 yuan in TCM syndrome differentiation group and 5603 yuan in Chinese medicine combined group. The cost-effectiveness ratios of the three groups were 65 in Western medicine group, 84 in TCM syndrome differentiation group and 56. Taking the curative effect of TCM group as reference, the incremental cost of Western medicine group and Chinese traditional medicine combination group were 30 and 26 respectively, that is, for each additional curative effect unit, the western medicine group needed to increase the cost by 30 yuan, and the Chinese and western combination group had to increase the cost by 26 yuan. Sensitivity analysis also proves the reliability of the results. Conclusion: the curative effect of the combination of Chinese and western medicine is better than that of TCM syndrome differentiation and western medicine. The adverse drug reactions in the combination group and TCM syndrome differentiation group were less than those in the western medicine group, and the improvement of cough, self-sweating and colds were also better than that in the western medicine group. From the point of view of pharmacoeconomics, the combination of Chinese and Western groups is the most reasonable of the three therapeutic schemes.
【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R563.9

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