恩替卡韦和拉米夫定治疗早期慢加急性肝衰竭的成本-效果分析
Cost-effectiveness analysis of entecavir and lamivudine in treatment of early stage acute-on-chronic liver failure
目的 从药物经济学的角度比较恩替卡韦和拉米夫定治疗早期慢加急性肝衰竭(ACLF)的短期疗效和成本,并分析ACLF的预后影响因素.方法 49例早期ACLF患者入组,其中包括恩替卡韦组28例和拉米夫定组21例.比较12同时两组患者的死亡率、住院时间、费用,以及肝功能、凝血功能、终末期肝病模型评分(MELD)的变化.采用成本-效果比值法和最小成本分析法对两种治疗方法进行药物经济学评价.结果 两组患者死亡率、住院时间、总费用的差异均无统计学意义(P>0.05).拉米夫定组的成本-效果比值较恩替卡韦组高;COX回归分析显示自发性腹膜炎和第2周时MELD评分是影响预后的主要因素(P均<0.01).结论 与拉米夫定相比,恩替卡韦虽不能提高早期ACLF患者的短期生存率,但是在药物经济学评价方面优于拉米夫定.
更多Objective To evaluate the cost-effectiveness of entecavir and lamivudine in treatment of early stage acute on chronic liver failure (ACLF),and analyze the predictive factors.Methods Forty nine patients with early ACLF were enrolled.Of which,28 patients were treated with entecavir,and 21 patients were treated with lamivudine.Mortality,length of hospital stay,cost,liver function,coagulation function,and model for end-stage liver disease (MELD) score were compared between two groups.Pharmacoeconomic evaluation was taken using cost-effectiveness analysis and cost minimization analysis.Results Mortality,length of hospital stay and cost had no significant difference between two groups.Ratio of costeffectiveness in lamivudine group was higher than that in entecavir group.Cox analysis showed that primary peritonitis and MELD score at the end of the second week were the main predictive factors.Conclusions Entecavir cannot improve the survival rate of early stage ACLF compared to lamivudine,but may provide economic benefit to patients with early stage ALCF.
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