甘草酸制剂预防肺癌化疗所致肝损伤的药物经济学评价

目的:研究3种甘草酸制剂对非小细胞肺癌患者化疗药物致肝损伤的预防作用及安全性,并进行药物经济学评价,为临床合理选用甘草酸制剂提供参考.方法:回顾性收集2018年1月～2019年12月本院非小细胞肺癌化疗适应证的患者176例,分为A组(预防性使用异甘草酸镁,45例)、B组(预防性使用复方甘草酸苷组,44例)、C组(预防性使用复方甘草酸单铵S,45例)与D组(未预防性使用保肝药,42例),运用成本-效果与增量成本-效果比分析评价药物经济学,并对其敏感性分析.结果:A、B、C、D组4种预防方案总有效率及显效率分别为95.56％、86.36％、75.56％、69.05％及86.67％、75.00％、66.67％、28.57％;A、B、C、D组4种预防方案的成本分别为1705.84元、1651.38元、1682.39元、2837.87元;A、B、C、D组4种预防方案的总有效率及显效率的C/E值分别为1785.10、1912.20、2226.56、4109.88及1968.20、2201.84、2523.46、9933.04;C组与D组为绝对劣势方案.如果决策者认为平均增加一个患者达到治疗总有效及显效的最大支付意愿值分别大于591.96元、466.67元是值得的,则A方案最经济,反之则B方案最经济,敏感性分析与结果保持一致.结论:在非小细胞肺癌患者化疗预防药物致肝损伤时,可以依据患者的支付意愿来选择保肝药,鼓励选择异甘草酸镁.

Pharmacoeconomic Evaluation of Glycyrrhizic Acid Preparations in Preventing Liver Injury Caused by Chemotherapy for Lung Cancer

Objective: To study the preventive effects and safety of three glycyrrhizic acid preparations on liver injury induced by chemotherapy in patients with non-small cell lung cancer (NSCLC), and to make pharmacoeconomic evaluation, so as to provide reference for clinical rational selection of glycyrrhizic acid preparations. Methods: From January 2018 to December 2019, 176 cases of NSCLC patients with systemic chemotherapy indications in our hospital were collected, and through retrospective review of medical records, they were divided into group A (preventive use of magnesium isoglycyrrhizinate, 45 cases), group B (preventive use of Compound Glycyrrhizin group, 44 cases), group C (preventive use of compound glycyrrhizinate monoamines, 45 cases) and group D (no preventive use of hepatoprotective drugs, 42 cases). Pharmacoeconomic evaluations were done by cost-effectiveness and incremental cost-effectiveness ratio analysis, including sensitivity tests. Results: The total effective rates and marked effective rates of group A, B, C, D were 95.56%, 86.36%, 75.56%, 69.05% and 86.67%, 75.00%, 66.67%, 28.57%, respectively. The costs of the four prevention schemes in groups A, B, C, D were 1705.84 yuan, 1651.38 yuan, 1682.39 yuan, 2837.87 yuan, respectively. The C/E values of total effective rate and marked effective rate of the four prevention schemes in groups A, B, C, D were 1785.10, 1912.20, 2226.56, 4109.88 and 1968.20, 2201.84, 2523.46, 9933.04, respectively, the schemes of Group C and group D were absolutely inferior. If decision makers believe it worthwhile that for an average increase of one patient reaches the total effective and marked effective treatment the maximum willingness to pay is more than 591.96 yuan and 466.67 yuan, respectively, then scheme A is the most economical, on the contrary, scheme B is the most economical, and the sensitivity analysis confirmed the results. Conclusions: In preventing drug-induced liver injury caused by chemotherapy for patients with non-small cell lung cancer, liver protecting drugs can be selected according to the patient''s willingness to pay, and magnesium isoglycyrrhizate is encouraged to be selected.