临床常用大品种药品综合评价研究

发布时间：2018-05-07 15:58

本文选题：头孢曲松 + 兰索拉唑　；参考：《山东中医药大学》2014年硕士论文

【摘要】：目的：通过搜集查阅头孢曲松、兰索拉唑、美罗培南药品说明书，国内外主要数据库相关文献，进行筛选整理，对其上市以来的临床疗效、经济学等方面进行总结归纳并建立综合评价资料，以期为临床合理用药提供依据。方法：1.Meta分析：计算机检索英文数据库Pubmed、Cochrane图书馆、Embase、Medline，中文数据库中国知网、万方、维普全文期刊数据库，确定头孢曲松、兰索拉唑、美罗培南的适应症及对照药品，全世界范围内搜集关于此三种药物与对照药治疗相应疾病的随机对照试验。采用RevMan5.0软件进行数据分析。2.经济学评价：依据Meta分析与专家咨询对三个药物建立决策树模型，根据山东省物价局-医药价格网得到成本价格进行成本-效果分析，，最后对所得结果进行敏感性分析。结果：1.头孢曲松对照药品：依诺沙星、环丙沙星、头孢克肟。适应疾病：非复杂性淋病(Uncomplicated gonorrhoea)。Meta分析共纳入8个随机对照试验，1441患者进行了治愈率比较，疗效评定指标只针对治疗5～8天后非复杂性淋病治愈率，没有对其它指标进行分析，几种药物在治疗非复杂性淋病中的远期疗效差异不明显。经济学评价中，通过成本-效果分析，结果环丙沙星组治疗淋病CER、ICER均最低，表明环丙沙星组为治疗非复杂性淋病期望值最高的药物，敏感性分析表明结果稳定。2.兰索拉唑对照药品：埃索美拉唑、奥美拉唑、泮托拉唑。适应疾病：胃食管反流病(gastroesophageal reflux disease,GERD)。Meta分析共纳入11个随机对照试验，9345患者进行了治愈率比较，疗效评定指标只针对治疗4周、8周后胃食管反流病治愈率，没有对其它指标进行分析，各种质子泵抑制剂（proton pump inhibitors,PPIs）在治疗GERD中的远期疗效差异不明显。经济学评价中，通过成本-效果分析，结果奥美拉唑CER、ICER均为4药中最低，故本研究中，奥美拉唑为治疗胃食管反流病期望值最高的药物，敏感性分析表明结果稳定。3.美罗培南对照药品：亚胺培南/西司他丁。适应疾病：腹腔感染(intra-abdominal infections)。Meta分析共纳入5个随机对照试验，861患者进行了治愈率比较，疗效评定指标只针对治疗约5~10天后腹腔感染治愈率，没有对其它指标进行分析，两种药物在治疗腹腔感染中的远期疗效差异不明显。经济学评价中，通过成本-效果分析，亚胺培南/西司他丁CER、ICER均最低，故亚胺培南/西司他丁为治疗腹腔感染期望值较高的药物，敏感性分析表明结果稳定。结论：本课题对头孢曲松、兰索拉唑、美罗培南临床疗效进行了Meta分析，经济学评价，方法科学合理、准确可行。
[Abstract]:Objective: to analyze the clinical efficacy of ceftriaxone, lansoprazole, meropenem, and the related documents of main databases at home and abroad, and to find out the clinical efficacy of ceftriaxone, lansoprazole and meropenem. In order to provide the basis for rational use of drugs in clinic, the economic aspects are summarized and summarized and comprehensive evaluation data are established. Methods 1. Meta-analysis: computer-based search of the English database Pubmedmedan Cochrane Library Embase Medline, Chinese database China Zhiwang, Wanfang, Weip full-text journal database, determination of ceftriaxone, lansoprazole, meropenem indications and control drugs. A randomized controlled trial of the three drugs and control drugs for the treatment of the disease was collected worldwide. Using RevMan5.0 software for data analysis. 2. Economic evaluation: according to Meta analysis and expert consultation, the decision tree model of three drugs was established, and the cost-effect analysis was carried out according to Shandong Price Bureau and Pharmaceutical Price Network. Finally, the sensitivity of the results was analyzed. The result is 1: 1. Ceftriaxone control drug: enoxacin, ciprofloxacin, cefixime. Adaptive disease: the cure rate of non-complicated gonorrhea patients was compared in 8 randomized controlled trials of 14 41 patients with non-complicated gonorrhea by gonorrhoea).Meta analysis. The evaluation index of curative effect was only for the cure rate of non-complicated gonorrhea after 5 ~ 8 days treatment, but no analysis was made on other indexes. The long-term effects of several drugs in the treatment of non-complicated gonorrhea are not significant. In the economic evaluation, the results of cost-effect analysis showed that ciprofloxacin group had the lowest CERICER for gonorrhea, indicating that ciprofloxacin group was the most expected drug for the treatment of non-complicated gonorrhea, and sensitivity analysis showed that the results were stable. Lansoprazole control drug: esomeprazole, omeprazole, Pam Tora. Adaptive disease: gastroesophageal reflux disease GERDN. Meta-analysis was conducted in 11 randomized controlled trials (n = 9 345) to compare the cure rate. The curative effect evaluation index was only for the cure rate of gastroesophageal reflux disease after 4 weeks and 8 weeks of treatment, but no analysis was made on other indexes. There was no significant difference between proton pump inhibitors and PPIsin in the treatment of GERD. In economic evaluation, cost-effect analysis showed that omeprazole CERICER was the lowest of the 4 drugs. Therefore, omeprazole was the most expected drug in the treatment of gastroesophageal reflux disease. The sensitivity analysis showed that the results were stable. 3. Meropenem: imipenem / cilastatin. Adaptive disease: Intraperitoneal infection intra-abdominal infections).Meta analysis was used to compare the cure rate of 5 randomized controlled trials in 861 patients. The curative effect evaluation index was only aimed at the cure rate of abdominal infection after 5 ~ 10 days of treatment, but no analysis was made on other indexes. There was no significant difference between the two drugs in the treatment of abdominal infection. In the economic evaluation, imipenem / cilastatin ICER was the lowest by cost-effect analysis, so imipenem / cilastatin was the most expected drug for the treatment of abdominal infection. The sensitivity analysis showed that the results were stable. Conclusion: the clinical effects of ceftriaxone, lansoprazole and meropenem were analyzed by Meta.
【学位授予单位】：山东中医药大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R969

【参考文献】