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痛风患者使用别嘌醇或非布司他治疗前行HLA-B*58：01基因多态性检测的成本-效果分析
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| 篇名： | 痛风患者使用别嘌醇或非布司他治疗前行HLA-B*58：01基因多态性检测的成本-效果分析 |
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| 摘要： | 目的：为痛风患者优选药物治疗方案提供参考。方法：收集莆田学院附属医院2016年7月1日－2017年7月1日收治的符合痛风临床诊断标准的患者107例，按照是否进行人类白细胞抗原B（HLA-B）*58：01基因检测将受试者分为A、B组。A组患者按照基因检测结果分为阳性、阴性2个亚组，阳性亚组给予非布司他40 mg，qd；阴性亚组给予别嘌醇300 mg，tid，2周为1个疗程，1个疗程后检测尿酸水平，若未达标则改用非布司他40 mg，qd治疗。B组患者给予别嘌醇治疗，1个疗程后检测尿酸水平，若未达标则改用非布司他治疗，用法用量与A组相同。两组患者均治疗6个月。考察两组患者治疗前后的尿酸水平，评价治疗达标情况；并电话随访两组患者的欧洲五维健康量表评分，以质量调整生命年（QALY）评价治疗效果；计算两组患者的成本-效果，并进行敏感度分析。结果：治疗前，两组患者的尿酸水平比较，差异无统计学意义（P＞0.05）；治疗后，两组患者尿酸水平显著低于同组治疗前，差异有统计学意义（P＜0.05）。A组的治疗效果为0.818 QALY，B组为0.808 QALY，两组比较差异无统计学意义（P＞0.05）。A组患者的治疗成本为3 932.46元，B组为2 174.92元，两组的成本-效果比分别为4 807.41和2 691.73，A组明显高于B组，表明B组方案更具成本-效果优势。敏感性分析支持此结果。两组患者的不良反应发生率比较，差异无统计学意义（P＞0.05）。结论：痛风患者不进行基因检测直接选用别嘌醇治疗的方案更具成本-效果优势。 |
| ABSTRACT： | OBJECTIVE： To provide reference for optimizing gout drug therapy plan. METHODS： A total of 107 patients met gout clinical diagnosis criteria in the Affiliated Hospital of Putian University during Jul. 1st， 2016- Jul. 1st， 2017 were divided into group A and B according to carrying out HLA-B*58：01 gene detection or not. Group A was divided into positive and negative subgroup according to the results of gene detection. Positive subgroup was given febuxostat 40 mg， qd. Negative subgroup was given allopurinol 300 mg， tid with a treatment course for 2 weeks， the level of uric acid was detected after a treatment course； febuxostat was given instead if the level of uric acid was not up to the standard. Group B was given allopurinol； after a treatment course， the level of uric acid was detected； febuxostat was given instead （usage and dosage as group A） if the level of uric acid was not up to the standard. Both groups were treated for 6 months. The levels of uric acid were investigated in 2 groups before and after treatment so as to evaluate up-to-standard rate of treatment. European 5-D health scale of 2 groups were followed up with telephone to calculate therapeutic efficacy by QALY. Cost-effectiveness of 2 groups were calculated， and sensitivity analysis was conducted. RESULTS： Before treatment， there was no statistical significance in urine acid levels between 2 groups （P＞0.05）. After treatment， urine acid levels of 2 groups were significantly lower than before treatment with statistical significance （P＜0.05）. Therapeutic effectiveness was 0.818 QALY in group A and 0.808 QALY in group B， without statistical significance between 2 groups （P＞0.05）. The cost of group A was 3 932.46 yuan， and that of group B was 2 174.92 yuan. Cost-effectiveness ratio of 2 groups were 4 807.41 and 2 691.73， and group A was significantly higher than group B. The therapy plan of group B showed that cost-effectiveness advantage. Sensitivity analysis supported the results. There was no statistical significance in the incidence of ADR between 2 groups （P＞0.05）. CONCLUSIONS： It shows cost-effectiveness advantage to directly use allopurinol without gene detection in gout patients. |
| 期刊： | 2018年第29卷第10期 |
| 作者： | 李喃君，林健，张超凤 |
| AUTHORS： | LI Nanjun，LIN Jian，ZHANG Chaofeng |
| 关键字： | 痛风；HLA-B*58：01基因；别嘌醇；非布司他；成本-效果分析 |
| KEYWORDS： | Gout； HLA-B*58：01 gene； Allopurinol； Febuxostat； Cost-effectiveness analysis |
| 阅读数： | 1137 次 |
| 本月下载数： | 8 次 |
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