糖尿病儿童胰岛素皮下注射及胰岛素泵治疗方法的药物经济学评价

摘要

目的 评价糖尿病儿童胰岛素皮下注射及胰岛素泵治疗方法的药物经济学.方法 选取2016年1月至2017年6月河北省儿童医院1型糖尿病儿童78例,参考随机数字表法,按照1:1比例将纳入儿童随机分为观察组和对照组(各39例).观察组采用胰岛素泵治疗,对照组采用胰岛素泵皮下注射,观察两组儿童血糖水平变化、糖化血红蛋白(HbA1c)、低血糖发生率、胰岛素用量、血糖达标时间、经济学指标(成本 -效果比、敏感度).结果 观察组儿童血糖控制总有效率为100.000%,高于对照组的84.615%,差异有统计学意义(χ2=3.450,P<0.05).观察组血糖达标时间(4.621 ± 1.402)d、住院时间(6.312 ± 1.454)d、胰岛素用量(24.614 ± 5.307)U/d、胰岛素费用(73.382 ± 3.573)元、成本效果敏感度(0.732 ± 0.042)、低血糖发生率(0)均低于对照组的(7.929 ± 2.671)d、(10.043 ± 2.113)d、(37.135 ± 8.112)U/d、(103.284 ± 5.109)元、1.223 ± 0.064、10.256%,差异均有统计学意义(t值分别为3.320、3.194、3.005、3.548、3.002,χ2=4.000,均 P<0.05).结论 糖尿病儿童应用胰岛素泵治疗优于胰岛素皮下注射方法,疗效显著、安全、经济,利于平衡疗效与成本间关系,是一种可行的治疗方法,建议优先使用.%Objective To evaluate the pharmacoeconomics of insulin subcutaneous injection and insulin pump therapy for children with diabetes.Methods A total of 78 children with type 1 diabetes in Children's Hospital of Hebei Province during January 2016 to June 2017 were selected.According to the random number table method,the children were randomly divided into observation group and control group(39 cases in each group)at the ratio of 1:1.The children in the observation group were treated with the insulin pump therapy,while the children in the control group was treated with insulin subcutaneous injection.The changes in blood glucose levels,glycosylated hemoglobin(HbA1c),incidence of hypoglycemia,insulin dosage,time of reaching target glucose,economic index(cost-effectiveness ratio,sensitivity)of the children in two groups were observed.Results The total effective rate of blood glucose control of children in the observation group was 100.000%,which was significantly higher than 84.615% in the control group with significant difference(χ2=3.450,P<0.05).In the observation group,the time of reaching target glucose(4.621 ± 1.402d),the hospitalization time(6.312 ± 1.454d),the insulin dosage(24.614 ± 5.307U/d),the insulin cost(RMB73.382 ± 3.573),the cost-effectiveness sensitivity(0.732 ± 0.042),and the incidence of hypoglycemia(0)were lower than those in the control group(7.929 ± 2.671d,10.043 ± 2.113d,37.135 ± 8.112U/d,RMB103.284 ± 5.109,1.223 ± 0.064,10.256%)with significant differences(t value was 3.320,3.194,3.005,3.548 and 3.002,respectively,χ2=4.000,all P<0.05).Conclusion For the children with diabetes,the insulin pump therapy is superior to insulin subcutaneous injection,which is a safe,economical and feasible therapy with notable efficacy.It helps to balance the relationship between efficacy and cost,which is recommended to give priority to use.