贝叶斯混合处理比较法对类风湿性关节炎类药物的成本—效果分析

发布时间：2018-03-06 09:06

本文选题：类风湿性关节炎　切入点：贝叶斯法　出处：《广东药科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:类风湿性关节炎作为一种病程持久且较难治愈的慢性疾病,有着较高的致畸率和致残率。这不但严重降低了个人的幸福指数,也使家庭使国家承担了极重的医疗卫生开支。随着各类新药的不断问世,如何在众多药物中选择成本与效果均衡的最优药物,成为亟待解决的问题。本文对贝叶斯MTC法的基本原理、优势及其应用前景做了简要介绍,对其在国内外各领域的发展与应用进行梳理,研究其在我国的应用与发展前景。本研究将以治疗类风湿性关节炎的5类药物为例,阐明贝叶斯MCT法在应用过程中的分析原理和步骤,以达到综合评估药效、对药物进行药物经济学评价的目的,以期拓宽药物经济学研究思路,为模型选择提供借鉴,为临床合理用药及相关部门制定政策提供有效信息,更好地为决策者进行科学决策提供理论支持。方法:通过检索国内数据库,得到相关已发表的临床随机对照试验并进行筛选。运用Win BUGS1.4.3软件构造随机效应模型,对5类抗类风湿性关节炎药物进行药效评价,并通过成本-效果分析法,对有效性、安全性及经济性的优劣排序。结果:通过检索数据库和筛选文献,最终获得22篇文献纳入研究分析,对数据收集与整理后,运用贝叶斯MTC法对药效进行分析,并对5类抗类风湿性关节炎药物用药前后血沉值、有效率等指标进行综合评估。以治疗前后血沉降低幅度为效果评价指标进行药效排序为:中药汤剂非甾体抗炎药中药单体和提取物中药复方制剂慢作用抗风湿药,其中中药汤剂的成本效果比和中药复方制剂的比值相当,非甾体抗炎药的成本效果比值最小。以治疗前后药物有效率为效果评价指标进行药效排序为:中药汤剂中药复方制非甾体抗炎药中药单体和提取物剂慢作用抗风湿药,其中中药汤剂的成本效果比值最大,非甾体抗炎药的成本效果比值最小。结论:通过将贝叶斯MTC法运用于成本-效果分析,能够得到RA药物治疗效果与成本的综合评估,当每增加一单位效应值所增加的成本值在患者经济支付能力范围内时,应该首选中药汤剂或中药复方制剂进行治疗。贝叶斯MTC法能够较好的弥补当前研究方法中的局限性,从而为政策决策者及临床医师选择最优药物提供决策信息参考,为临床合理用药提供建议。
[Abstract]:Objective: rheumatoid arthritis (RA), as a chronic disease with a long and difficult course of treatment, has a high rate of teratogenicity and disability. It also puts a heavy burden on the country's health care spending. With the advent of new drugs of all kinds, how to choose the most cost-effective and effective drugs among the many drugs, In this paper, the basic principle, advantages and application prospects of Bayesian MTC method are briefly introduced, and its development and application in various fields at home and abroad are summarized. To study its application and development prospect in China, this study will take 5 kinds of drugs for treating rheumatoid arthritis as an example, expound the analysis principle and procedure of Bayesian MCT method in the process of application, in order to achieve the comprehensive evaluation of drug efficacy. The purpose of pharmacoeconomic evaluation of drugs is to broaden the thinking of pharmacoeconomics research, to provide reference for model selection, and to provide effective information for clinical rational use of drugs and the formulation of policies by relevant departments. Methods: by searching the domestic database, the published clinical randomized controlled trials were obtained and screened. The random effect model was constructed by using Win BUGS1.4.3 software. Five kinds of anti-rheumatoid arthritis drugs were evaluated for their efficacy, efficacy, safety and economy by cost-effect analysis. Finally, 22 articles were collected and analyzed. After data collection and collation, Bayesian MTC method was used to analyze the efficacy and ESR of 5 kinds of anti-rheumatoid arthritis drugs before and after treatment. The effective rate and other indexes were comprehensively evaluated. The order of pharmacodynamics was as follows: traditional Chinese medicine decoction, non-steroidal anti-inflammatory drugs, traditional Chinese medicine monomer and extract Chinese traditional medicine compound preparation slow action anti-rheumatism drug, Among them, the cost effect ratio of traditional Chinese medicine decoction is similar to that of traditional Chinese medicine compound preparation. The cost-effect ratio of non-steroidal anti-inflammatory drugs was the least. The cost effect ratio of traditional Chinese medicine decoction is the largest, and that of non-steroidal anti-inflammatory drug is the least. Conclusion: by applying Bayesian MTC method to cost-effect analysis, the comprehensive evaluation of therapeutic effect and cost of RA drug can be obtained. When the cost of each additional unit effect value is within the range of the patient's economic ability to pay, the Chinese medicine decoction or compound Chinese medicine preparation should be the first choice for treatment. Bayesian MTC method can make up for the limitations of the current research methods. It can provide decision information reference for policy decision makers and clinicians to choose the best drugs, and offer suggestions for rational use of drugs in clinic.
【学位授予单位】：广东药科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R956

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