麻荆止咳颗粒联合莫西沙星治疗成人非重症社区获得性肺炎的药物经济学评价

郑沁鈊 韦京贝 张瑜 郑宓 张松青

[摘要] 目的 觀察院内制剂麻荆止咳颗粒联合莫西沙星注射液治疗非重症社区获得性肺炎（CAP）的疗效和经济性。 方法 采用回顾性分析，纳入2020年1—12月收治的非重症成人CAP住院患者的病历48例。对照组（n=30）住院期间单独给予莫西沙星注射液，观察组（n=18）在对照组基础上加用麻荆止咳颗粒，比较两组患者治疗前后症状积分改善情况、症状积分总有效率、临床总有效率、成本、CMA比较、敏感性分析、单病种控费受影响程度。 结果 观察组和对照组治疗前后的症状积分组内比较均有明显改善（P<0.05）;但改善程度组间比较，差异无统计学意义（P>0.05）;两组临床总有效率分别为94.44%和80.00%，差异无统计学意义（P>0.05）;使用最小成本法（CMA）比较显示，观察组成本为7837.46元，低于对照组的9773.78元，观察组有最优性价比;通过敏感性分析，药物成本波动±10%，观察组经济性仍优于对照组（观察组vs.治疗组：-10%，7053.71元 vs. 8796.40元;+10%：8621.21元 vs. 10 751.16元），分析结果具有一致性。敏感性分析后经济性仍未改变，其经济性对单病种控费无影响（P>0.05）。结论 两组疗效相当，观察组经济性更优，但对单病种控费无影响。

[关键词] 社区获得性肺炎;麻荆止咳颗粒;莫西沙星注射液;成本-效果分析

[中图分类号] R562.2          [文献标识码] B          [文章编号] 1673-9701（2021）34-0109-04

[Abstract] Objective To observe the efficacy and economy of the hospital preparation， the Majing cough granule， combined with the moxifloxacin injection in the treatment of non-severe community-acquired pneumonia （CAP）. Methods A total of 48 non-severe adult patients with CAP who were hospitalized from January to December 2012 were included in the retrospective analysis. A total of 30 patients in the control group were given the moxifloxacin injection alone during hospitalization， and 18 patients in the observation group were given the Majing cough granule in addition to the control group. The improvement of the symptom score， total response rate of the symptom score， total clinical effective rate， cost， comparison of CMA， sensitivity analysis and degree of influence on the cost control of single disease were compared between the two groups before and after treatment. Results Symptom scores of the observation group and the control group were significantly improved after treatment compared with those before treatment（P<0.05）， but no statistically significant difference was observed in the improvement degree between the 2 groups（P>0.05）. The total clinical effective rates of the two groups were 94.44% and 80%， respectively， with no statistically significant difference in efficacy（P>0.05）.The comparison with the minimum cost method （CMA） showed that the cost of 7837.46 yuan in the observation group was lower than the cost of 9773.78 yuan in the control group， and the observation group had the best cost performance ratio. According to the sensitivity analysis， the drug cost fluctuated by ±10%， and the economical efficiency of the observation group was still better than that of the control group（the observation group vs. the treatment group： -10%， 7053.71 vs. 8796.40 yuan;+10%：8621.21 yuan vs. 10 751.16 yuan），and the analysis results were consistent.The Economical efficiency remained unchanged after the sensitivity analysis， and had no influence on the cost control of single disease（P>0.05）. Conclusion The two groups have similar efficacy， and the economical efficiency of the observation group is better， but it has no effect on the cost control of single disease.

[Key words] Community-acquired pneumonia （CAP）; Majing cough granule; Moxifloxacin injection; Cost-effectiveness analysis

社区获得性肺炎（Community-acquired pneumonia，CAP）一般是指医院外罹患的细菌性肺炎，我国目前仅有CAP年龄构成比的研究，尚无成人CAP的发病率数据。2013年一项国内研究显示，16 585例住院患者中>65岁（28.7%）和<5岁（37.3%）人群比例远高于26～45岁青壮年（9.2%）[1-2]。CAP普通患者一般疗程3～7 d，而患有基础性疾病或感染耐药率高的病原体的患者疗程更长，治疗费用昂贵。随着DRGs付费模式推广，药品费占医疗总费用比例受到严格控制，CAP治疗方案多样化，临床治疗CAP时不仅要考虑药品的有效性和安全性评价，还要参考不同药物治疗方案的经济学评价。目前疗效评价文献证明，中药联合/替代抗菌药的疗效显著，有减少抗菌药应用、减少住院天数、减少成本等优点[3-7]。但中药联合抗菌药治疗CAP的药物经济学文献匮乏，临床缺乏经济性参考会影响中药的应用。本研究采用回顾性分析对麻荆止咳颗粒联合莫西沙星和单独使用莫西沙星注射液组进行疗效评价和药物经济学（Pharmaceutical economics，PE）分析，希望能为临床中西药结合治疗CAP和医保控费提供参考，现报道如下。

1 资料与方法

1.1 一般资料

选取福建中医药大学附属第二人民医院住院呼吸科2020年1—12月的患者住院病历。

1.2 病例筛选

在202……