Abstract
Objective To make a comparative analysis of the cost - effectiveness of the eradication of Helicobacter pylori( Hp) infection in patients with chronic gastritis and peptic ulcer by standard triple therapy and quadruple therapy containing bismuth. Methods From December 2014 to October 2015,400 Uygur patients who were definitely diagnosed with chronic gastritis and peptic ulcer by gastroscopy,showed positive for 13 C-UBT,and were diagnosed with Hp infection were enrolled from the People's Hospital of Xinjiang Uygur Autonomous Region. Using random number table,the subjects were divided into four groups:group A(pantoprazole + clarithromycin + metronidazole;PCM),group B( pantoprazole + clarithromycin +amoxicillin;PCA),group C(bismuth pectin + pantoprazole + clarithromycin + metronidazole;BPCM)and group D(bismuth pectin + pantoprazole + clarithromycin + amoxicillin;BPCA). After treatment for 14 days,the cost - effectiveness analysis was conducted. The adverse effects were observed and recorded during treatment. The rate of Hp eradication was analyzed by the intention - to - treat(ITT)analysis and per protocol(PP)analysis. Results In group A,group B,group C and group D, there were respectively 98,99,97 and 97 patients who completed the whole treatment. The four groups were not significantly different in the remission rate on day 1,day 3,day 7 and day 14(P > 0. 05). According to ITT analysis,the eradication rate of A,B,C,D group was 80. 0% (80 / 100),86. 0% (86 / 100),90. 0% (90 / 100)and 93. 0% (93 / 100)respectively, with significant differences among the four groups(χ2 = 8. 52,P < 0. 05),and the rate was 81. 6% (80 / 98),86. 9% (86/ 99),92. 8% (90 / 97)and 95. 9% (93 / 97) respectively according to PP analysis,with significant differences among the four groups( χ2 = 12. 22,P < 0. 05). Group D was higher than group B in Hp eradication rate( P < 0. 07). In the four groups,there were respectively 2(2. 0% ),3(3. 0% ),4(4. 1% ) and 4(4. 1% )patients who had adverse reactions, and the four groups were not significantly different in the incidence of adverse reactions( χ2 = 1. 02,P > 0. 05). The cost -effectiveness ratio of the four groups was 7. 57,7. 23,7. 01 and 6. 90. The therapy with the lowest cost was taken as the reference in incremental cost - effectiveness ratio〔ΔC/ ΔE = (C1 - C2) / (E1 - E2)〕,and ΔC/ ΔE of other therapies was calculated. Group A which had the lowest cost was taken as the reference,and the ΔC/ ΔE of group B,C and D was 1. 90, 3. 04 and 3. 08 respectively. Conclusion From the perspective of ΔC/ ΔE, the therapy of proton pump inhibitor, clarithromycin and amoxicillin is more economic and rational for the eradication of Hp.关键词
三联疗法/四联疗法/铋/幽门螺杆菌/成本 - 效果分析Key words
Triple therapy/Quadruple therapy/Bismuth/Helicobacter pylori/Cost - effectiveness analysis分类
医药卫生
