本文選題：基本藥物目錄 + 成本效果分析��； 參考：《山西醫(yī)科大學》2014年碩士論文

【摘要】：研究目的 本研究旨在通過對某三甲醫(yī)院基本藥物使用情況的調查，分析基本藥物使用情況，利用藥物經(jīng)濟學評價方法，對質子泵抑制劑類藥物進行經(jīng)濟學評價，為臨床合理用藥提供參考依據(jù)，從而提高醫(yī)院基本藥物使用率。 研究方法 首先，從醫(yī)院信息科HIS數(shù)據(jù)庫系統(tǒng)提取2010年1月到2012年12月每個月化學藥物和生物制劑消耗記錄，包括藥物名稱、規(guī)格、劑型、零售價格、用量等具體指標。參照2009版《國家基本藥物目錄（化學藥物和生物制物）》和2010版《山西省增補目錄》對基本藥物進行標記，并結合第十七版《新編藥物學》、《國家基本藥物臨床應用指南》和文獻報道，確定藥物限定日劑量（DDD），利用Excel2010建立數(shù)據(jù)庫，對數(shù)據(jù)有序輸入和統(tǒng)計。 其次，計算出該醫(yī)院使用的國家基本藥物占《國家基本藥物目錄》中藥物品種數(shù)的比例，以及醫(yī)院使用山西省增補藥物占《山西省增補目錄》中藥物品種數(shù)的比例；計算出每個月的基本藥物銷售金額占醫(yī)院所有藥物銷售金額比例，以及基本藥物與全部藥物年銷售金額排序；根據(jù)公式計算結果，對基本藥物中針劑的DDDs、DDDc進行排序。對各統(tǒng)計數(shù)據(jù)列表、繪圖并結合醫(yī)院實際情況描述性分析。 最后，根據(jù)基本藥物使用調查結果，確定質子泵抑制劑類藥物為研究對象，收集將此類藥物作為首選治療上消化道出血的病例，按給藥方案不同分為四組，A組靜脈注射7天奧美拉唑鈉粉針，B組靜脈注射7天埃索美拉唑粉針，C組靜脈注射7天蘭索拉唑粉針，D組序貫療法即先靜脈注射5天埃索美拉唑粉針然后口服2天埃索美拉唑腸溶片。觀察各組療效，采用藥物經(jīng)濟學分析方法，比較四組治療方案經(jīng)濟學價值。 研究結果 調查結果顯示，2010-2012年基本藥物品種使用的率分別為：54.6%、63.8%、81.08%；2010-2012年基本藥物銷售金額占所有藥物銷售金額比例的平均值分別為：19.69%、18.36%、18.77%；基本藥物院內使用流向構成比結果：門診藥房與住院部藥房具有相近的品種使用率，住院部藥房占所有銷售金額比例約三分之二；基本藥物分類消耗在前幾位的分別是：抗微生物藥、消化系統(tǒng)用藥、心血管系統(tǒng)用藥；在2010年和2011年基本藥物金額排序第一位的是奧美拉唑鈉粉針；藥物用藥頻度處于前三位的是：復方甘草酸苷、復方氨基酸、氨溴索針劑；日用藥金額處于前三位的是：奧美拉唑鈉、美洛西林舒巴坦、頭孢哌酮舒巴坦鈉。 經(jīng)濟學評價結果為，治療效果最好的給藥方案是靜脈注射7天的埃索美拉唑鈉，其有效率為87.5%，成本效果比值為2224；第二的是靜脈注射7天的蘭索拉唑和序貫組即前5天靜脈注射埃索美拉唑鈉后2天口服埃索美拉唑鈉腸溶片的序貫組，有效率均為84.34，成本效果比分別為1598.53和1539.70；相對較差的是靜脈注射7天的奧美拉唑鈉，有效率為81.25，成本效果比為1723.08。但是四種治療方案療效無統(tǒng)計學差異，最有經(jīng)濟學價值的是序貫療法。 結論 1、某醫(yī)院使用基本藥物品種數(shù)量占整個基本藥物目錄品種范圍的80%以上，基本藥物使用率大于15%，符合衛(wèi)生部在2009年對國家基本藥物的使用提出的要求。 2、對質子泵抑制劑類藥物的經(jīng)濟學評價，序貫組療法即先靜注埃索美拉唑鈉再口服腸溶片的治療方案具有最小的成本效果比值，，更具有經(jīng)濟學價值。
[Abstract]:research objective
The purpose of this study is to evaluate the use of basic drugs in a three a hospital, analyze the use of basic drugs, and use the method of pharmacoeconomic evaluation to evaluate the drug of proton pump inhibitors in order to provide a reference for rational use of drugs in clinic, and to improve the use rate of Basic Medicine in medical hospital.
research method
First, from the HIS database system of the hospital information section, the records of the consumption of chemicals and biologics per month from January 2010 to December 2012 were extracted, including the name, specification, dosage form, retail price and dosage of the drug, including the 2009 edition of the national basic drugs catalogue (chemical and biological substances) and the 2010 edition of the supplement catalogue of Shanxi province. The drug was marked, and combined with the seventeenth edition of the new pharmacology, the national guidelines for the clinical application of basic drugs and the literature, the daily dose (DDD) was defined, the database was established by Excel2010, and the data were entered and counted in order.
Secondly, the proportion of the basic national drugs used in the hospital, the proportion of the national basic drugs catalogue, the number of articles of Chinese medicine, and the proportion of the supplementary drugs in Shanxi province to the addition of the supplement catalogue in Shanxi Province, and the proportion of the articles of Chinese medicine are calculated, and the amount of the basic drug sales amount per month is calculated and the basis of the proportion of all drug sales in the hospital and the base of the hospital are calculated. In order to order the annual sales amount of the drug and all the drugs, according to the results of the formula, the DDDs and DDDc of the drugs in the basic drugs are sorted. The list of statistical data, drawing and combining with the actual situation of the hospital are described.
Finally, according to the results of the basic drug use survey, the proton pump inhibitors were selected as the research object, and the drugs were selected as the first choice for the treatment of upper gastrointestinal bleeding. According to the different regimen, four groups were divided into four groups. Group A was injected with omeprazole sodium powder for 7 days, group B was injected with esomeprazole powder for 7 days, and group C was injected for 7 days. The sequential therapy of group D was followed by intravenous injection of esomeprazole for 5 days and oral esomeprazole enteric tablets for 2 days. The therapeutic effects were observed and the economic value of the four groups was compared by pharmacoeconomic analysis.
Research results
The results of the survey showed that the rate of the use of the basic drugs for 2010-2012 years were 54.6%, 63.8%, 81.08%, and the average sales amount of the basic drugs for 2010-2012 years accounted for 19.69%, 18.36%, 18.77%, respectively, and the distribution ratio of the basic drugs in hospital: the outpatient pharmacy and the inpatient pharmacy. The rate of use was nearly 2/3 in the inpatient pharmacy, and the first few of the basic drugs were the antimicrobial agents, the digestive system, the cardiovascular system, the first of the basic drugs in 2010 and 2011 were omeprazole sodium powder; the drug use frequency was in the DDDs. The first three are: compound glycyrrhizin, compound amino acid, ambroxol needle; the first three are omeprazole sodium, meloxicine sulbactam, cefoperazone sulbactam sodium.
The result of the economic evaluation was that the best treatment regimen was the 7 day intravenous injection of esomeprazole sodium with an effective rate of 87.5% and a cost effect ratio of 2224; second was the sequential group of esomeprazole sodium enteric coated tablets for 7 days of intravenous injection of lansoprazole and the sequential group, the first 5 days after the intravenous injection of esomeprazole sodium for the first 5 days. The efficiency was 84.34, the cost effect ratio was 1598.53 and 1539.70, the relatively poor was the 7 day intravenous omeprazole sodium, the effective rate was 81.25, the cost effect was 1723.08. but the four treatment regimen had no statistical difference, the most economical value was sequential therapy.
conclusion
1, the number of basic drugs used in a hospital accounts for more than 80% of the range of the whole basic drug catalogue, and the use of basic drugs is more than 15%, which is in line with the requirements of the Ministry of health on the use of national basic drugs in 2009.
2, for the economic evaluation of proton pump inhibitors, sequential group therapy, that is, the treatment regimen of first intravenous injection of esomeprazole sodium and then oral enteric tablets has the minimum cost effect ratio, and is of more economic value.

【學位授予單位】：山西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R95

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