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丹参酮ⅡA磺酸钠治疗冠心病心绞痛的药物经济学评价 Δ

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刘 洁 ，万楚川，陈 磊，席晓宇（中国药科大学国家药物政策与医药产业经济研究中心，南京 211198）
中图分类号 R541.4；R956 文献标志码 A 文章编号 1001-0408（2020）18-2240-07
DOI 10.6039/j.issn.1001-0408.2020.18.12

摘 要 目的：评估丹参酮ⅡA磺酸钠注射液联合常规用药对比常规用药治疗冠心病心绞痛的临床疗效和经济性。方法：以“丹参
酮Ⅱ A磺酸钠”“丹参酮”“心绞痛”“Sodium tanshinoneⅡ A sulfonate”“STS”“Danshentong”“Angina pectoris”等为中英文关键词，组合
检索万方数据、中国知网、中国生物医学文献数据库、Cochrane图书馆、Medline、Embase、ISI Web of Science、BIOSIS Previews等数
据库，检索时限均为建库起至2019年4月。筛选文献、提取资料后按照Cochrane系统评价员手册5.2.0偏倚风险工具对纳入的真
实世界队列研究进行质量评价，采用Stata 15.0软件进行Meta分析，并对结果进行发表偏倚分析；采用成本-效果分析进行药物经
济学评价，并对结果进行单因素敏感性分析和概率敏感性分析。结果：共纳入29篇文献，共计31项研究、2 857例患者。Meta分析
结果显示，试验组患者的临床有效率[RR＝1.23，95％CI（1.18，1.28），P＜0.001]、心电图有效率[RR＝1.29，95％CI（1.20，1.39），P＜
0.001]、心绞痛有效率 [RR＝1.22，95％CI（1.15，1.29），P＜0.001]均显著高于对照组；两组患者的不良反应均较轻微；上述结果存在
发表偏倚的可能性大。成本-效果分析显示，两种方案的增量成本-效果比为72.02；敏感性分析显示上述结果稳健。结论：对于冠
心病心绞痛患者，丹参酮Ⅱ A磺酸钠注射液联合常规用药方案对比常规用药方案的疗效更优，成本也略高；当支付意愿高于7 202
元时，联合方案更具有成本-效果优势。
关键词 丹参酮ⅡA磺酸钠；冠心病心绞痛；Meta分析；疗效；成本-效果分析

Pharmacoeconomic Evaluation of Sodium Tanshinone ⅡⅡ A Sulfonate in the Treatment of Angina Pectoris of
Coronary Heart Disease
LIU Jie，WAN Chuchuan，CHEN Lei，XI Xiaoyu（National Drug Policy and Pharmaceutical Industry Economic
Research Center，China Pharmaceutical University，Nanjing 211198，China）

ABSTRACT OBJECTIVE：To evaluate the clinical efficacy and economics of Sodium tanshinone Ⅱ A sulfonate injection
combined with conventional medication versus conventional medication in the treatment of angina pectoris of coronary heart
disease. METHODS：Using“Sodium tanshinone Ⅱ A sulfonate”“Danshentong”“angina pectoris”as Chinese keywords and
“Sodium tanshinone Ⅱ A sulfonate”“Danshentong”“Angina pectoris”as English keywords，the studies were retrieved from
Wanfang database，CNKI，CBM，Cochrane Library，Medline，Embase，ISI Web of Science and BIOSIS Previews during the
inception to Apr. 2019. After literature screening and data extraction，the included real world cohort studies were evaluated with
bias risk tool of Cochrane systematic evaluator manual 5.2.0. Meta-analysis was conducted by using Stata 15.0 software，and
publication bias of results was analyzed. The cost-effectiveness analysis was used for pharmacoeconomic evaluate，and single factor
sensitivity analysis and probability sensitivity analysis were carried out for the results of pharmacoeconomic evaluation. RESULTS：
A total of 29 literatures were included，involving 31 studies and 2 857 patients. Meta-analysis showed that clinical effective
rate [RR＝1.23，95％CI（1.18，1.28），P＜0.001]，ECG effective rate [RR＝1.29，95％CI（1.20，1.39），P＜0.001] and angina
pectoris effective rate [RR＝1.22，95％CI（1.15，1.29），P＜0.001] of trial group were significantly higher than those of control group.
The adverse reactions of the two groups were mild. The above results were likely to be biased in publication. Cost-effectiveness
analysis showed that ICER was 72.02 of 2 groups. The sensitivity analysis showed that above results were stable. CONCLUSIONS：
For patients with angina pectoris of coronary heart disease，therapeutic efficacy of Sodium tanshinone Ⅱ A sulfonate injection
combined with conventional medication is better that of conventional medication，and the cost is also slightly higher. When the
willingness to pay is higher than 7 202 yuan，the combination scheme has the advantage of cost-effectiveness.
KEYWORDS Sodium tanshinone Ⅱ A sulfonate；Angina pectoris of coronary heart disease；Meta-analysis；Therapeutic efficacy；
Cost-effectiveness analysis；

Δ 基金项目：江苏省教育厅高校哲学社会科学研究一般项目 冠心病心绞痛是由于心肌急剧的、暂时的供氧和需
（No.2019SJA0062）；中国药科大学“双一流”学科创新团队建设项目 氧不平衡所引起的临床综合征。一项欧洲研究发现，
（No.CPU2018GY39）
45～54 岁的心绞痛患病率女性为 0.1％～1％、男性为
＊硕士研究生。研究方向：卫生经济学与药学服务。E-mail：lj-
2％～5％，而 65～74 岁的患病率则猛增至女性 10％～
belle@163.com
[1]
15％、男性 10％～20％ 。一项针对我国冠心病患者的
# 通信作者：讲师，博士。研究方向：卫生经济学与药学服务。
E-mail：cpuxixiaoyu@163.com 疾病经济负担研究结果显示，2016年我国居民冠心病的
·2240 · China Pharmacy 2020 Vol. 31 No. 18 中国药房 2020年第31卷第18期