某院基本药物使用现况与质子泵抑制剂经济学分析

发布时间：2018-05-16 06:25

本文选题：基本药物目录 + 成本效果分析　；参考：《山西医科大学》2014年硕士论文

【摘要】：研究目的本研究旨在通过对某三甲医院基本药物使用情况的调查，分析基本药物使用情况，利用药物经济学评价方法，对质子泵抑制剂类药物进行经济学评价，为临床合理用药提供参考依据，从而提高医院基本药物使用率。研究方法首先，从医院信息科HIS数据库系统提取2010年1月到2012年12月每个月化学药物和生物制剂消耗记录，包括药物名称、规格、剂型、零售价格、用量等具体指标。参照2009版《国家基本药物目录（化学药物和生物制物）》和2010版《山西省增补目录》对基本药物进行标记，并结合第十七版《新编药物学》、《国家基本药物临床应用指南》和文献报道，确定药物限定日剂量（DDD），利用Excel2010建立数据库，对数据有序输入和统计。其次，计算出该医院使用的国家基本药物占《国家基本药物目录》中药物品种数的比例，以及医院使用山西省增补药物占《山西省增补目录》中药物品种数的比例；计算出每个月的基本药物销售金额占医院所有药物销售金额比例，以及基本药物与全部药物年销售金额排序；根据公式计算结果，对基本药物中针剂的DDDs、DDDc进行排序。对各统计数据列表、绘图并结合医院实际情况描述性分析。最后，根据基本药物使用调查结果，确定质子泵抑制剂类药物为研究对象，收集将此类药物作为首选治疗上消化道出血的病例，按给药方案不同分为四组，A组静脉注射7天奥美拉唑钠粉针，B组静脉注射7天埃索美拉唑粉针，C组静脉注射7天兰索拉唑粉针，D组序贯疗法即先静脉注射5天埃索美拉唑粉针然后口服2天埃索美拉唑肠溶片。观察各组疗效，采用药物经济学分析方法，比较四组治疗方案经济学价值。研究结果调查结果显示，2010-2012年基本药物品种使用的率分别为：54.6%、63.8%、81.08%；2010-2012年基本药物销售金额占所有药物销售金额比例的平均值分别为：19.69%、18.36%、18.77%；基本药物院内使用流向构成比结果：门诊药房与住院部药房具有相近的品种使用率，住院部药房占所有销售金额比例约三分之二；基本药物分类消耗在前几位的分别是：抗微生物药、消化系统用药、心血管系统用药；在2010年和2011年基本药物金额排序第一位的是奥美拉唑钠粉针；药物用药频度处于前三位的是：复方甘草酸苷、复方氨基酸、氨溴索针剂；日用药金额处于前三位的是：奥美拉唑钠、美洛西林舒巴坦、头孢哌酮舒巴坦钠。经济学评价结果为，治疗效果最好的给药方案是静脉注射7天的埃索美拉唑钠，其有效率为87.5%，成本效果比值为2224；第二的是静脉注射7天的兰索拉唑和序贯组即前5天静脉注射埃索美拉唑钠后2天口服埃索美拉唑钠肠溶片的序贯组，有效率均为84.34，成本效果比分别为1598.53和1539.70；相对较差的是静脉注射7天的奥美拉唑钠，有效率为81.25，成本效果比为1723.08。但是四种治疗方案疗效无统计学差异，最有经济学价值的是序贯疗法。结论 1、某医院使用基本药物品种数量占整个基本药物目录品种范围的80%以上，基本药物使用率大于15%，符合卫生部在2009年对国家基本药物的使用提出的要求。 2、对质子泵抑制剂类药物的经济学评价，序贯组疗法即先静注埃索美拉唑钠再口服肠溶片的治疗方案具有最小的成本效果比值，，更具有经济学价值。
[Abstract]:research objective
The purpose of this study is to evaluate the use of basic drugs in a three a hospital, analyze the use of basic drugs, and use the method of pharmacoeconomic evaluation to evaluate the drug of proton pump inhibitors in order to provide a reference for rational use of drugs in clinic, and to improve the use rate of Basic Medicine in medical hospital.
research method
First, from the HIS database system of the hospital information section, the records of the consumption of chemicals and biologics per month from January 2010 to December 2012 were extracted, including the name, specification, dosage form, retail price and dosage of the drug, including the 2009 edition of the national basic drugs catalogue (chemical and biological substances) and the 2010 edition of the supplement catalogue of Shanxi province. The drug was marked, and combined with the seventeenth edition of the new pharmacology, the national guidelines for the clinical application of basic drugs and the literature, the daily dose (DDD) was defined, the database was established by Excel2010, and the data were entered and counted in order.
Secondly, the proportion of the basic national drugs used in the hospital, the proportion of the national basic drugs catalogue, the number of articles of Chinese medicine, and the proportion of the supplementary drugs in Shanxi province to the addition of the supplement catalogue in Shanxi Province, and the proportion of the articles of Chinese medicine are calculated, and the amount of the basic drug sales amount per month is calculated and the basis of the proportion of all drug sales in the hospital and the base of the hospital are calculated. In order to order the annual sales amount of the drug and all the drugs, according to the results of the formula, the DDDs and DDDc of the drugs in the basic drugs are sorted. The list of statistical data, drawing and combining with the actual situation of the hospital are described.
Finally, according to the results of the basic drug use survey, the proton pump inhibitors were selected as the research object, and the drugs were selected as the first choice for the treatment of upper gastrointestinal bleeding. According to the different regimen, four groups were divided into four groups. Group A was injected with omeprazole sodium powder for 7 days, group B was injected with esomeprazole powder for 7 days, and group C was injected for 7 days. The sequential therapy of group D was followed by intravenous injection of esomeprazole for 5 days and oral esomeprazole enteric tablets for 2 days. The therapeutic effects were observed and the economic value of the four groups was compared by pharmacoeconomic analysis.
Research results
The results of the survey showed that the rate of the use of the basic drugs for 2010-2012 years were 54.6%, 63.8%, 81.08%, and the average sales amount of the basic drugs for 2010-2012 years accounted for 19.69%, 18.36%, 18.77%, respectively, and the distribution ratio of the basic drugs in hospital: the outpatient pharmacy and the inpatient pharmacy. The rate of use was nearly 2/3 in the inpatient pharmacy, and the first few of the basic drugs were the antimicrobial agents, the digestive system, the cardiovascular system, the first of the basic drugs in 2010 and 2011 were omeprazole sodium powder; the drug use frequency was in the DDDs. The first three are: compound glycyrrhizin, compound amino acid, ambroxol needle; the first three are omeprazole sodium, meloxicine sulbactam, cefoperazone sulbactam sodium.
The result of the economic evaluation was that the best treatment regimen was the 7 day intravenous injection of esomeprazole sodium with an effective rate of 87.5% and a cost effect ratio of 2224; second was the sequential group of esomeprazole sodium enteric coated tablets for 7 days of intravenous injection of lansoprazole and the sequential group, the first 5 days after the intravenous injection of esomeprazole sodium for the first 5 days. The efficiency was 84.34, the cost effect ratio was 1598.53 and 1539.70, the relatively poor was the 7 day intravenous omeprazole sodium, the effective rate was 81.25, the cost effect was 1723.08. but the four treatment regimen had no statistical difference, the most economical value was sequential therapy.
conclusion
1, the number of basic drugs used in a hospital accounts for more than 80% of the range of the whole basic drug catalogue, and the use of basic drugs is more than 15%, which is in line with the requirements of the Ministry of health on the use of national basic drugs in 2009.
2, for the economic evaluation of proton pump inhibitors, sequential group therapy, that is, the treatment regimen of first intravenous injection of esomeprazole sodium and then oral enteric tablets has the minimum cost effect ratio, and is of more economic value.

【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R95

【参考文献】