本文選題：類(lèi)風(fēng)濕性關(guān)節(jié)炎　切入點(diǎn)：貝葉斯法　出處：《廣東藥科大學(xué)》2017年碩士論文　論文類(lèi)型：學(xué)位論文

【摘要】：目的:類(lèi)風(fēng)濕性關(guān)節(jié)炎作為一種病程持久且較難治愈的慢性疾病,有著較高的致畸率和致殘率。這不但嚴(yán)重降低了個(gè)人的幸福指數(shù),也使家庭使國(guó)家承擔(dān)了極重的醫(yī)療衛(wèi)生開(kāi)支。隨著各類(lèi)新藥的不斷問(wèn)世,如何在眾多藥物中選擇成本與效果均衡的最優(yōu)藥物,成為亟待解決的問(wèn)題。本文對(duì)貝葉斯MTC法的基本原理、優(yōu)勢(shì)及其應(yīng)用前景做了簡(jiǎn)要介紹,對(duì)其在國(guó)內(nèi)外各領(lǐng)域的發(fā)展與應(yīng)用進(jìn)行梳理,研究其在我國(guó)的應(yīng)用與發(fā)展前景。本研究將以治療類(lèi)風(fēng)濕性關(guān)節(jié)炎的5類(lèi)藥物為例,闡明貝葉斯MCT法在應(yīng)用過(guò)程中的分析原理和步驟,以達(dá)到綜合評(píng)估藥效、對(duì)藥物進(jìn)行藥物經(jīng)濟(jì)學(xué)評(píng)價(jià)的目的,以期拓寬藥物經(jīng)濟(jì)學(xué)研究思路,為模型選擇提供借鑒,為臨床合理用藥及相關(guān)部門(mén)制定政策提供有效信息,更好地為決策者進(jìn)行科學(xué)決策提供理論支持。方法:通過(guò)檢索國(guó)內(nèi)數(shù)據(jù)庫(kù),得到相關(guān)已發(fā)表的臨床隨機(jī)對(duì)照試驗(yàn)并進(jìn)行篩選。運(yùn)用Win BUGS1.4.3軟件構(gòu)造隨機(jī)效應(yīng)模型,對(duì)5類(lèi)抗類(lèi)風(fēng)濕性關(guān)節(jié)炎藥物進(jìn)行藥效評(píng)價(jià),并通過(guò)成本-效果分析法,對(duì)有效性、安全性及經(jīng)濟(jì)性的優(yōu)劣排序。結(jié)果:通過(guò)檢索數(shù)據(jù)庫(kù)和篩選文獻(xiàn),最終獲得22篇文獻(xiàn)納入研究分析,對(duì)數(shù)據(jù)收集與整理后,運(yùn)用貝葉斯MTC法對(duì)藥效進(jìn)行分析,并對(duì)5類(lèi)抗類(lèi)風(fēng)濕性關(guān)節(jié)炎藥物用藥前后血沉值、有效率等指標(biāo)進(jìn)行綜合評(píng)估。以治療前后血沉降低幅度為效果評(píng)價(jià)指標(biāo)進(jìn)行藥效排序?yàn)?中藥湯劑非甾體抗炎藥中藥單體和提取物中藥復(fù)方制劑慢作用抗風(fēng)濕藥,其中中藥湯劑的成本效果比和中藥復(fù)方制劑的比值相當(dāng),非甾體抗炎藥的成本效果比值最小。以治療前后藥物有效率為效果評(píng)價(jià)指標(biāo)進(jìn)行藥效排序?yàn)?中藥湯劑中藥復(fù)方制非甾體抗炎藥中藥單體和提取物劑慢作用抗風(fēng)濕藥,其中中藥湯劑的成本效果比值最大,非甾體抗炎藥的成本效果比值最小。結(jié)論:通過(guò)將貝葉斯MTC法運(yùn)用于成本-效果分析,能夠得到RA藥物治療效果與成本的綜合評(píng)估,當(dāng)每增加一單位效應(yīng)值所增加的成本值在患者經(jīng)濟(jì)支付能力范圍內(nèi)時(shí),應(yīng)該首選中藥湯劑或中藥復(fù)方制劑進(jìn)行治療。貝葉斯MTC法能夠較好的彌補(bǔ)當(dāng)前研究方法中的局限性,從而為政策決策者及臨床醫(yī)師選擇最優(yōu)藥物提供決策信息參考,為臨床合理用藥提供建議。
[Abstract]:Objective: rheumatoid arthritis (RA), as a chronic disease with a long and difficult course of treatment, has a high rate of teratogenicity and disability. It also puts a heavy burden on the country's health care spending. With the advent of new drugs of all kinds, how to choose the most cost-effective and effective drugs among the many drugs, In this paper, the basic principle, advantages and application prospects of Bayesian MTC method are briefly introduced, and its development and application in various fields at home and abroad are summarized. To study its application and development prospect in China, this study will take 5 kinds of drugs for treating rheumatoid arthritis as an example, expound the analysis principle and procedure of Bayesian MCT method in the process of application, in order to achieve the comprehensive evaluation of drug efficacy. The purpose of pharmacoeconomic evaluation of drugs is to broaden the thinking of pharmacoeconomics research, to provide reference for model selection, and to provide effective information for clinical rational use of drugs and the formulation of policies by relevant departments. Methods: by searching the domestic database, the published clinical randomized controlled trials were obtained and screened. The random effect model was constructed by using Win BUGS1.4.3 software. Five kinds of anti-rheumatoid arthritis drugs were evaluated for their efficacy, efficacy, safety and economy by cost-effect analysis. Finally, 22 articles were collected and analyzed. After data collection and collation, Bayesian MTC method was used to analyze the efficacy and ESR of 5 kinds of anti-rheumatoid arthritis drugs before and after treatment. The effective rate and other indexes were comprehensively evaluated. The order of pharmacodynamics was as follows: traditional Chinese medicine decoction, non-steroidal anti-inflammatory drugs, traditional Chinese medicine monomer and extract Chinese traditional medicine compound preparation slow action anti-rheumatism drug, Among them, the cost effect ratio of traditional Chinese medicine decoction is similar to that of traditional Chinese medicine compound preparation. The cost-effect ratio of non-steroidal anti-inflammatory drugs was the least. The cost effect ratio of traditional Chinese medicine decoction is the largest, and that of non-steroidal anti-inflammatory drug is the least. Conclusion: by applying Bayesian MTC method to cost-effect analysis, the comprehensive evaluation of therapeutic effect and cost of RA drug can be obtained. When the cost of each additional unit effect value is within the range of the patient's economic ability to pay, the Chinese medicine decoction or compound Chinese medicine preparation should be the first choice for treatment. Bayesian MTC method can make up for the limitations of the current research methods. It can provide decision information reference for policy decision makers and clinicians to choose the best drugs, and offer suggestions for rational use of drugs in clinic.
【學(xué)位授予單位】：廣東藥科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R956

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