电针为主的三种疗法治疗LDH所致坐骨神经痛的临床疗效和卫生经济学评价
发布时间：2019-05-12 11:32
【摘要】：目的： 评价电针、电针联合牵引、电针联合牵引西药三种疗法治疗腰椎间盘突出(LDH)所致坐骨神经痛的成本-效果分析、成本.效用分析,筛选成本较低、疗效较优的疗法。 方法： 1.临床疗效评价： 采用临床随机、对照试验设计,将符合纳入标准的324例LDH所致坐骨神经痛患者随机分为电针组(A组)、电针联合牵引组(B组)、电针联合牵引西药组(口服扶他林、维生素B1)(C组)。疗程为6周。在入组时、治疗第1周、2周、3周、4周、5周、6周及随访第12周使用简化麦吉尔疼痛量表(SF-MPQ)及改良罗兰功能问卷(MRDQ)进行疗效评价。 2.卫生经济学评价： 采用SF-MPQ及MRDQ作为效果值指标,与成本相对比,获得成本-效果比(CER)。采用基于SF-36的英国SF-6D效用评分模型计算效用值,获得三种疗法的质量调整生命年(QALY),与成本相对比,获得成本-效用比(CUR)及增量成本-效用比(ICUR)。进一步采用敏感性分析检验结果的可靠性。 结果： 1.临床疗效评价结果： 三组之间基线一致,可比性良好。治疗6周后三组SF-MPQ评分、MRDQ评分均呈明显下降,SF-MPQ评分分别下降51.5±21.2分、55.6±25.2分、54.1±23.7分,MRDQ评分分别下降9.1±5.0分、9.8±4.7分、8.3±4.7分,且存在显著的时间效应(P0.01)。治疗前后三组SF-MPQ评分、MRDQ评分差异均具有显著的统计学意义(P0.01),但三组之间在各个评价时间点的评分差异无统计学意义(P0.05)。 2.卫生经济学评价结果： (1)成本分析：治疗6周后,三组患者治疗所花费的总成本分别为1867.3元、2204.4元、2242.4元,三组之间总成本的差异具有统计学意义(P0.01)。由于临床疗效评价结果中显示三组疗效差异无统计学意义,符合最小成本分析的应用条件,最小成本分析结果提示达到同样临床疗效,A组成本最低。 (2)成本-效果分析：SF-MPQ评分每减少1分,A、B、C组分别花费37.55元、42.91元、42.97元；MRDQ评分每减少1分,A、B、C组分别花费212.52元、243.43元、280.1元：A组CER最低,即达到同样的治疗效果,A组的平均成本低于另外两组。 (3)成本-效用分析：三组每获得1个QALY,分别需要花费23831.55元、28870.99元、28379.27元,A组的CUR最小。从ICUR分析来看,B、C组相对于A组每多获得1个QALY要多花费305189.19元、507662.34元,均超过了社会的支付意愿(38354元)。进一步敏感性分析显示,将评分模型、价格在设定的范围内变化对分析结果无影响。 结论： 1.电针、电针联合牵引、电针联合牵引西药均可有效降低LDH所致坐骨神经痛的疼痛评分,并改善运动功能评分,且疗效相当。 2.同联合疗法相比较,电针可能足治疗LDH所致坐骨神经痛成本最低,且成本-效果及成本-效用最优的疗法。
[Abstract]:Objective: to evaluate the cost-effectiveness analysis and cost of electro-acupuncture combined with traction of western medicine in the treatment of sciatica caused by lumbar disc protrusion (LDH). The utility analysis shows that the screening cost is low and the curative effect is better. Method: 1. Clinical efficacy evaluation: 324 patients with sciatica caused by LDH were randomly divided into acupuncture group (group A) and electro-acupuncture combined traction group (group B). EA combined with traction western medicine group (oral Futalin, vitamin B1) (C group). The course of treatment was 6 weeks. At the first week, 2 weeks, 3 weeks, 4 weeks, 5 weeks, 6 weeks and 12 weeks of follow-up, the curative effect was evaluated by simplified McGill pain scale (SF-MPQ) and modified Roland function questionnaire (MRDQ). 2. Health economics evaluation: SF-MPQ and MRDQ were used as the index of effect value, and compared with cost, the cost-effectiveness ratio (CER). Was obtained. The utility value of British SF-6D utility score model based on SF-36 is calculated. The quality adjusted life year (QALY), of three treatments is compared with the cost, and the cost-utility ratio (CUR) and incremental cost-utility ratio (ICUR). Are obtained. Furthermore, sensitivity analysis was used to test the reliability of the results. Result: 1. The results of clinical efficacy evaluation: the baseline of the three groups was the same and the comparability was good. After 6 weeks of treatment, the SF-MPQ score and MRDQ score of the three groups decreased significantly, the SF-MPQ score decreased 51.5 卤21.2 points, 55.6 卤25.2 points, 54.1 卤23.7 points, and the MRDQ score decreased 9.1 卤5.0 points and 9.8 卤4.7 points, respectively. 8.3 卤4.7 points, and there was a significant time effect (P 0.01). There were significant differences in SF-MPQ score and MRDQ score between the three groups before and after treatment (P 0.01), but there was no significant difference in the scores among the three groups at each evaluation time point (P 0.05). 2. The results of health economics evaluation: (1) cost analysis: after 6 weeks of treatment, the total cost of treatment in the three groups was 1867.3 yuan, 2204.4 yuan and 2242.4 yuan, respectively. The difference of total cost among the three groups was statistically significant (P 0.01). Because the results of clinical efficacy evaluation showed that there was no significant difference among the three groups, which was in accordance with the application conditions of minimum cost analysis, the results of minimum cost analysis suggested that the same clinical efficacy was achieved, and the cost of group A was the lowest. (2) cost-effectiveness analysis: for each decrease of SF-MPQ score, A, B and C spent 37.55 yuan, 42.91 yuan and 42.97 yuan, respectively. For each decrease of MRDQ score, A, B, C spent 212.52 yuan, 243.43 yuan and 280.1 yuan, respectively. Group A had the lowest CER, that is, to achieve the same therapeutic effect, and the average cost of group A was lower than that of the other two groups. (3) cost-utility analysis: the cost of each QALY, in group A was 23831.55 yuan, 28870.99 yuan and 28379.27 yuan, respectively, and the CUR in group A was the smallest. According to ICUR analysis, group C spent 305189.19 yuan and 507662.34 yuan more than group A to get an additional QALY, which exceeded the willingness of society to pay (38354 yuan). Further sensitivity analysis shows that the change of the scoring model and the price within the set range has no effect on the analysis results. Conclusion: 1. EA and EA combined with traction western medicine can effectively reduce the pain score of sciatica caused by LDH and improve the score of motor function, and the curative effect is the same. 2. Compared with combined therapy, electro-acupuncture may be the lowest cost, and the best cost-effectiveness and cost-effectiveness therapy in the treatment of sciatica caused by LDH.
【学位授予单位】：成都中医药大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R246.6
本文编号：2475357
[Abstract]:Objective: to evaluate the cost-effectiveness analysis and cost of electro-acupuncture combined with traction of western medicine in the treatment of sciatica caused by lumbar disc protrusion (LDH). The utility analysis shows that the screening cost is low and the curative effect is better. Method: 1. Clinical efficacy evaluation: 324 patients with sciatica caused by LDH were randomly divided into acupuncture group (group A) and electro-acupuncture combined traction group (group B). EA combined with traction western medicine group (oral Futalin, vitamin B1) (C group). The course of treatment was 6 weeks. At the first week, 2 weeks, 3 weeks, 4 weeks, 5 weeks, 6 weeks and 12 weeks of follow-up, the curative effect was evaluated by simplified McGill pain scale (SF-MPQ) and modified Roland function questionnaire (MRDQ). 2. Health economics evaluation: SF-MPQ and MRDQ were used as the index of effect value, and compared with cost, the cost-effectiveness ratio (CER). Was obtained. The utility value of British SF-6D utility score model based on SF-36 is calculated. The quality adjusted life year (QALY), of three treatments is compared with the cost, and the cost-utility ratio (CUR) and incremental cost-utility ratio (ICUR). Are obtained. Furthermore, sensitivity analysis was used to test the reliability of the results. Result: 1. The results of clinical efficacy evaluation: the baseline of the three groups was the same and the comparability was good. After 6 weeks of treatment, the SF-MPQ score and MRDQ score of the three groups decreased significantly, the SF-MPQ score decreased 51.5 卤21.2 points, 55.6 卤25.2 points, 54.1 卤23.7 points, and the MRDQ score decreased 9.1 卤5.0 points and 9.8 卤4.7 points, respectively. 8.3 卤4.7 points, and there was a significant time effect (P 0.01). There were significant differences in SF-MPQ score and MRDQ score between the three groups before and after treatment (P 0.01), but there was no significant difference in the scores among the three groups at each evaluation time point (P 0.05). 2. The results of health economics evaluation: (1) cost analysis: after 6 weeks of treatment, the total cost of treatment in the three groups was 1867.3 yuan, 2204.4 yuan and 2242.4 yuan, respectively. The difference of total cost among the three groups was statistically significant (P 0.01). Because the results of clinical efficacy evaluation showed that there was no significant difference among the three groups, which was in accordance with the application conditions of minimum cost analysis, the results of minimum cost analysis suggested that the same clinical efficacy was achieved, and the cost of group A was the lowest. (2) cost-effectiveness analysis: for each decrease of SF-MPQ score, A, B and C spent 37.55 yuan, 42.91 yuan and 42.97 yuan, respectively. For each decrease of MRDQ score, A, B, C spent 212.52 yuan, 243.43 yuan and 280.1 yuan, respectively. Group A had the lowest CER, that is, to achieve the same therapeutic effect, and the average cost of group A was lower than that of the other two groups. (3) cost-utility analysis: the cost of each QALY, in group A was 23831.55 yuan, 28870.99 yuan and 28379.27 yuan, respectively, and the CUR in group A was the smallest. According to ICUR analysis, group C spent 305189.19 yuan and 507662.34 yuan more than group A to get an additional QALY, which exceeded the willingness of society to pay (38354 yuan). Further sensitivity analysis shows that the change of the scoring model and the price within the set range has no effect on the analysis results. Conclusion: 1. EA and EA combined with traction western medicine can effectively reduce the pain score of sciatica caused by LDH and improve the score of motor function, and the curative effect is the same. 2. Compared with combined therapy, electro-acupuncture may be the lowest cost, and the best cost-effectiveness and cost-effectiveness therapy in the treatment of sciatica caused by LDH.
【学位授予单位】：成都中医药大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R246.6
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