摘要
目的比较左西孟旦和米力农用于重症心力衰竭合并正常、轻度损伤肾功能和中度损伤肾功能患者的药物经济学差异。方法回顾性收集2016年12月至2019年9月在山东省千佛山医院心血管内科住院并应用左西孟旦或米力农的711例患者信息,先按照肾功能分为肾功能中度损伤组(n=299)和肾功能正常或轻度损伤组(n=412),再根据所使用的正性肌力药物分为左西孟旦亚组和米力农亚组。通过电子病历系统和随访等方式收集患者给药后30 d的临床效果。构建决策树分析模型,分别以30 d内无不良临床事件发生率的显效率、30 d内无死亡事件发生的有效率作为效果指标,以贴现调整后的住院总费用作为成本,进行成本-效果分析和敏感性分析。结果肾功能中度损伤组:以显效率为指标,米力农具有绝对的药物经济学优势;以有效率为指标,左西孟旦每比米力农多增加1%的有效率,住院总费用需要多花4562.64元。肾功能正常或轻度损伤组:左西孟旦住院总费用低于米力农,米力农每比左西孟旦增加1%的显效率,住院总费用需要多花400.89元;每比左西孟旦增加1%的有效率,住院总费用需要多花1751.16元。敏感性分析结果稳健。结论基于真实世界数据研究发现,对于中度肾功能损伤患者,米力农较左西孟旦具有经济学优势;对于正常或轻度损伤肾功能患者,左西孟旦较米力农有一定经济学优势。
Objective To investigate the cost-effectiveness differences between levosimendan and milrinone in treating severe heart failure complicated with normal,mild and moderate impaired renal function.Methods A total of 711 patients hospitalized in the Cardiology Department of Shandong Provincial Qianfoshan Hospital due to severe heart failure during Dec.2016 and Sep.2019 were enrolled.According to the renal function,the patients were divided into moderate renal injury group(n=299)and normal renal function or mild renal injury group(n=412),and then divided into levosimendan subgroup and milrinone subgroup.The information and clinical outcomes of patients 30 days after drug use were collected through the electronic medical record system and follow-up visits.With“obvious efficiency”with no adverse clinical events,and“efficiency”with no death within 30 days as effectiveness indexes,and the discount adjusted total hospitalization cost as the cost index,a decision tree analysis model was constructed,and cost-effectiveness analysis and one-way sensitivity analysis were performed.Results In the moderate renal injury group,with“obvious efficiency”as the effectiveness index,milrinone had absolute pharmacoeconomic advantages;with“efficiency”as the effectiveness index,each 1%more efficiency of levosimendan costed￥4562.64 more than that of milrinone.In the normal renal function or mild renal injury group,the total hospitalization cost of levosimendan was lower than that of milrinone,and each 1%increase in obvious efficiency of milrinone costed￥400.89 more than that of levosimendan,and each 1%increase in efficiency of milrinone costed￥1751.16 more than that of levosimendan.The sensitivity analysis results were robust.Conclusion Based on real-world data,milrinone has an economic advantage over levosimendan in severe heart failure patients with moderate renal injury.For patients with normal renal function or mild renal injury,levosimendan has a moderate economic advantage over milrinone.
作者
董雪
赵霞
程子捷
韩毅
DONG Xue;ZHAO Xia;CHENG Zijie;HAN Yi(Centre for Health Management and Policy Research,School of Public Health,Cheeloo College of Medicine,Shandong University,Jinan 250012,Shandong,China;NHC Key Lab of Health Economics and Policy Research(Shandong University),Jinan 250012,Shandong,China;Department of Education,The First Affiliated Hospital of Shandong First Medical University&Shandong Provincial Qianfoshan Hospital,Jinan 250014,Shandong,China;Department of Clinical Pharmacy,The First Affiliated Hospital of Shandong First Medical University&Shandong Provincial Qianfoshan Hospital,Shandong Medicine and Health Key Laboratory of Clinical Pharmacy,Jinan 250014,Shandong,China;Department of Clinical Pharmacy,School of Basic Medicine,China Pharmaceutical University,Nanjing 210009,Jiangsu,China)
出处
《山东大学学报（医学版）》
CAS
北大核心
2022年第4期91-98,共8页
Journal of Shandong University:Health Sciences
基金
山东省重点研发计划(2020RKB14165)
山东省千佛山医院培育基金(QYPY2020NSFC0813)
