急诊内镜套扎联合奥曲肽治疗食管静脉曲张出血的成本-效果分析被引量：11

Cost-effectiveness analysis of emergency endoscopic variceal ligation plus octreotide in the treatment of acute esophageal variceal bleeding in cirrhotic patients

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摘要目的对急诊行内镜下食管静脉曲张套扎术(EVL)联合奥曲肽治疗与单用奥曲肽治疗两种方案控制急性食管静脉曲张破裂出血进行经济学分析,为临床选择合理治疗方案提供依据。方法 78例经内镜证实的食管静脉曲张破裂出血患者,分别采用急诊EVL联合奥曲肽治疗和单用奥曲肽治疗,观察两组疗效及其成本-效果比。结果两组患者一般资料及基础治疗相似,具有可比性。联合治疗组控制急性出血止血率明显高于单用奥曲肽组(94．4％ vs．78．6％,P=0．045),且并发症发生率低(19．4％ vs．42．9％,P=0．027);早期再出血率(2．9％ vs．7．7％,P=0．358)和死亡率 (5．6％ vs．14．3％,P=0．205)也低。联合治疗组平均止血时间、奥曲肽应用天数、输血量及平均住院时间明显低于单用奥曲肽组(P<0．001)。两组治疗的总费用平均每例分别为联合组9046．5元、奥曲肽组13 743．6元(P=0．045),内镜下套扎联合奥曲肽治疗的成本效果比明显优于单用奥曲肽治疗组。结论肝硬化食管静脉曲张破裂出血的治疗应在加强基础治疗的基础上,首先考虑应用成本-效果比低的急诊内镜下套扎联合奥曲肽治疗,其具有经济学价值优势。 Objective To compare and evaluate the cost and effectiveness of endoscopic variceal llgation（EVL） at emergency plus octreotide versus octreotide alone in the treatment of acute esophageal variceal bleeding in cirrhotic patients. Methods Seventy-elght patients with active variceal bleeding under emergency endoscope, were assigned to two groups receiving either combined therapy of EVL at emergency andoctreotlde （‘EVL＇ group） or a continuous infusion of octreotide alone（‘octreotide＇ group）. Both efficacy and cost-effectiveness were observed. Results There were no significant differences between the two groups in patients＇ characteristics, supporting treatment or general treatment. In group EVL, there appeared a significantly higher rate in controlling bleeding and lower complication rate than that of octreotide group（94.4 % vs. 78.6 % , P - 0. 045 and 19.4 % vs. 42.9 %, P =0. 027, respectively ）. Early rebleeding and mortality rate were also lower in group EVL, but with no significant differences between them （2.9% vs. 7.7%, P= 0.358 and 5.6% vs. 14.3%, P= 0.205, respectively）. The combined therapy had a significantly shorter time of hemostasis, less administration of octreoid, fewer units of blood transfusion and shorter hospital stay （ P 〈 0. 001 ）. The median costs of the combined therapy and octreotide alone were RMB 9046.5 Yuan and 13 743.6 Yuan, respectively （ P = 0. 045 ）. The cost-effective ratio of group EVL seemed superior to that of octreoid group. Conclusion The therapeutic scheme of emergency EVL plus octreotide was a more cost-effective one for controlling acute esophageal variceal bleeding.

作者张颖陈世耀于晓峰赵尚敏王一倩

机构地区上海华东医院消化科复旦大学附属中山医院消化科

出处《中华流行病学杂志》 CAS CSCD 北大核心 2006年第5期433-436,共4页 Chinese Journal of Epidemiology

关键词食管静脉曲张出血急诊内镜套扎治疗奥曲肽成本-效果分析食管静脉曲张套扎术 Esophageal variceal bleeding Emergency endoscopy Endoscopic variceal ligation Octreotide Cost-effective analysis

分类号 R575.2 [医药卫生—消化系统]

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