電針為主的三種療法治療LDH所致坐骨神經(jīng)痛的臨床療效和衛(wèi)生經(jīng)濟學(xué)評價
發(fā)布時間：2019-05-12 11:32
【摘要】：目的： 評價電針、電針聯(lián)合牽引、電針聯(lián)合牽引西藥三種療法治療腰椎間盤突出(LDH)所致坐骨神經(jīng)痛的成本-效果分析、成本.效用分析,篩選成本較低、療效較優(yōu)的療法。 方法： 1.臨床療效評價： 采用臨床隨機、對照試驗設(shè)計,將符合納入標(biāo)準(zhǔn)的324例LDH所致坐骨神經(jīng)痛患者隨機分為電針組(A組)、電針聯(lián)合牽引組(B組)、電針聯(lián)合牽引西藥組(口服扶他林、維生素B1)(C組)。療程為6周。在入組時、治療第1周、2周、3周、4周、5周、6周及隨訪第12周使用簡化麥吉爾疼痛量表(SF-MPQ)及改良羅蘭功能問卷(MRDQ)進行療效評價。 2.衛(wèi)生經(jīng)濟學(xué)評價： 采用SF-MPQ及MRDQ作為效果值指標(biāo),與成本相對比,獲得成本-效果比(CER)。采用基于SF-36的英國SF-6D效用評分模型計算效用值,獲得三種療法的質(zhì)量調(diào)整生命年(QALY),與成本相對比,獲得成本-效用比(CUR)及增量成本-效用比(ICUR)。進一步采用敏感性分析檢驗結(jié)果的可靠性。 結(jié)果： 1.臨床療效評價結(jié)果： 三組之間基線一致,可比性良好。治療6周后三組SF-MPQ評分、MRDQ評分均呈明顯下降,SF-MPQ評分分別下降51.5±21.2分、55.6±25.2分、54.1±23.7分,MRDQ評分分別下降9.1±5.0分、9.8±4.7分、8.3±4.7分,且存在顯著的時間效應(yīng)(P0.01)。治療前后三組SF-MPQ評分、MRDQ評分差異均具有顯著的統(tǒng)計學(xué)意義(P0.01),但三組之間在各個評價時間點的評分差異無統(tǒng)計學(xué)意義(P0.05)。 2.衛(wèi)生經(jīng)濟學(xué)評價結(jié)果： (1)成本分析：治療6周后,三組患者治療所花費的總成本分別為1867.3元、2204.4元、2242.4元,三組之間總成本的差異具有統(tǒng)計學(xué)意義(P0.01)。由于臨床療效評價結(jié)果中顯示三組療效差異無統(tǒng)計學(xué)意義,符合最小成本分析的應(yīng)用條件,最小成本分析結(jié)果提示達到同樣臨床療效,A組成本最低。 (2)成本-效果分析：SF-MPQ評分每減少1分,A、B、C組分別花費37.55元、42.91元、42.97元；MRDQ評分每減少1分,A、B、C組分別花費212.52元、243.43元、280.1元：A組CER最低,即達到同樣的治療效果,A組的平均成本低于另外兩組。 (3)成本-效用分析：三組每獲得1個QALY,分別需要花費23831.55元、28870.99元、28379.27元,A組的CUR最小。從ICUR分析來看,B、C組相對于A組每多獲得1個QALY要多花費305189.19元、507662.34元,均超過了社會的支付意愿(38354元)。進一步敏感性分析顯示,將評分模型、價格在設(shè)定的范圍內(nèi)變化對分析結(jié)果無影響。 結(jié)論： 1.電針、電針聯(lián)合牽引、電針聯(lián)合牽引西藥均可有效降低LDH所致坐骨神經(jīng)痛的疼痛評分,并改善運動功能評分,且療效相當(dāng)。 2.同聯(lián)合療法相比較,電針可能足治療LDH所致坐骨神經(jīng)痛成本最低,且成本-效果及成本-效用最優(yōu)的療法。
[Abstract]:Objective: to evaluate the cost-effectiveness analysis and cost of electro-acupuncture combined with traction of western medicine in the treatment of sciatica caused by lumbar disc protrusion (LDH). The utility analysis shows that the screening cost is low and the curative effect is better. Method: 1. Clinical efficacy evaluation: 324 patients with sciatica caused by LDH were randomly divided into acupuncture group (group A) and electro-acupuncture combined traction group (group B). EA combined with traction western medicine group (oral Futalin, vitamin B1) (C group). The course of treatment was 6 weeks. At the first week, 2 weeks, 3 weeks, 4 weeks, 5 weeks, 6 weeks and 12 weeks of follow-up, the curative effect was evaluated by simplified McGill pain scale (SF-MPQ) and modified Roland function questionnaire (MRDQ). 2. Health economics evaluation: SF-MPQ and MRDQ were used as the index of effect value, and compared with cost, the cost-effectiveness ratio (CER). Was obtained. The utility value of British SF-6D utility score model based on SF-36 is calculated. The quality adjusted life year (QALY), of three treatments is compared with the cost, and the cost-utility ratio (CUR) and incremental cost-utility ratio (ICUR). Are obtained. Furthermore, sensitivity analysis was used to test the reliability of the results. Result: 1. The results of clinical efficacy evaluation: the baseline of the three groups was the same and the comparability was good. After 6 weeks of treatment, the SF-MPQ score and MRDQ score of the three groups decreased significantly, the SF-MPQ score decreased 51.5 鹵21.2 points, 55.6 鹵25.2 points, 54.1 鹵23.7 points, and the MRDQ score decreased 9.1 鹵5.0 points and 9.8 鹵4.7 points, respectively. 8.3 鹵4.7 points, and there was a significant time effect (P 0.01). There were significant differences in SF-MPQ score and MRDQ score between the three groups before and after treatment (P 0.01), but there was no significant difference in the scores among the three groups at each evaluation time point (P 0.05). 2. The results of health economics evaluation: (1) cost analysis: after 6 weeks of treatment, the total cost of treatment in the three groups was 1867.3 yuan, 2204.4 yuan and 2242.4 yuan, respectively. The difference of total cost among the three groups was statistically significant (P 0.01). Because the results of clinical efficacy evaluation showed that there was no significant difference among the three groups, which was in accordance with the application conditions of minimum cost analysis, the results of minimum cost analysis suggested that the same clinical efficacy was achieved, and the cost of group A was the lowest. (2) cost-effectiveness analysis: for each decrease of SF-MPQ score, A, B and C spent 37.55 yuan, 42.91 yuan and 42.97 yuan, respectively. For each decrease of MRDQ score, A, B, C spent 212.52 yuan, 243.43 yuan and 280.1 yuan, respectively. Group A had the lowest CER, that is, to achieve the same therapeutic effect, and the average cost of group A was lower than that of the other two groups. (3) cost-utility analysis: the cost of each QALY, in group A was 23831.55 yuan, 28870.99 yuan and 28379.27 yuan, respectively, and the CUR in group A was the smallest. According to ICUR analysis, group C spent 305189.19 yuan and 507662.34 yuan more than group A to get an additional QALY, which exceeded the willingness of society to pay (38354 yuan). Further sensitivity analysis shows that the change of the scoring model and the price within the set range has no effect on the analysis results. Conclusion: 1. EA and EA combined with traction western medicine can effectively reduce the pain score of sciatica caused by LDH and improve the score of motor function, and the curative effect is the same. 2. Compared with combined therapy, electro-acupuncture may be the lowest cost, and the best cost-effectiveness and cost-effectiveness therapy in the treatment of sciatica caused by LDH.
【學(xué)位授予單位】：成都中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號】：R246.6
本文編號：2475357
[Abstract]:Objective: to evaluate the cost-effectiveness analysis and cost of electro-acupuncture combined with traction of western medicine in the treatment of sciatica caused by lumbar disc protrusion (LDH). The utility analysis shows that the screening cost is low and the curative effect is better. Method: 1. Clinical efficacy evaluation: 324 patients with sciatica caused by LDH were randomly divided into acupuncture group (group A) and electro-acupuncture combined traction group (group B). EA combined with traction western medicine group (oral Futalin, vitamin B1) (C group). The course of treatment was 6 weeks. At the first week, 2 weeks, 3 weeks, 4 weeks, 5 weeks, 6 weeks and 12 weeks of follow-up, the curative effect was evaluated by simplified McGill pain scale (SF-MPQ) and modified Roland function questionnaire (MRDQ). 2. Health economics evaluation: SF-MPQ and MRDQ were used as the index of effect value, and compared with cost, the cost-effectiveness ratio (CER). Was obtained. The utility value of British SF-6D utility score model based on SF-36 is calculated. The quality adjusted life year (QALY), of three treatments is compared with the cost, and the cost-utility ratio (CUR) and incremental cost-utility ratio (ICUR). Are obtained. Furthermore, sensitivity analysis was used to test the reliability of the results. Result: 1. The results of clinical efficacy evaluation: the baseline of the three groups was the same and the comparability was good. After 6 weeks of treatment, the SF-MPQ score and MRDQ score of the three groups decreased significantly, the SF-MPQ score decreased 51.5 鹵21.2 points, 55.6 鹵25.2 points, 54.1 鹵23.7 points, and the MRDQ score decreased 9.1 鹵5.0 points and 9.8 鹵4.7 points, respectively. 8.3 鹵4.7 points, and there was a significant time effect (P 0.01). There were significant differences in SF-MPQ score and MRDQ score between the three groups before and after treatment (P 0.01), but there was no significant difference in the scores among the three groups at each evaluation time point (P 0.05). 2. The results of health economics evaluation: (1) cost analysis: after 6 weeks of treatment, the total cost of treatment in the three groups was 1867.3 yuan, 2204.4 yuan and 2242.4 yuan, respectively. The difference of total cost among the three groups was statistically significant (P 0.01). Because the results of clinical efficacy evaluation showed that there was no significant difference among the three groups, which was in accordance with the application conditions of minimum cost analysis, the results of minimum cost analysis suggested that the same clinical efficacy was achieved, and the cost of group A was the lowest. (2) cost-effectiveness analysis: for each decrease of SF-MPQ score, A, B and C spent 37.55 yuan, 42.91 yuan and 42.97 yuan, respectively. For each decrease of MRDQ score, A, B, C spent 212.52 yuan, 243.43 yuan and 280.1 yuan, respectively. Group A had the lowest CER, that is, to achieve the same therapeutic effect, and the average cost of group A was lower than that of the other two groups. (3) cost-utility analysis: the cost of each QALY, in group A was 23831.55 yuan, 28870.99 yuan and 28379.27 yuan, respectively, and the CUR in group A was the smallest. According to ICUR analysis, group C spent 305189.19 yuan and 507662.34 yuan more than group A to get an additional QALY, which exceeded the willingness of society to pay (38354 yuan). Further sensitivity analysis shows that the change of the scoring model and the price within the set range has no effect on the analysis results. Conclusion: 1. EA and EA combined with traction western medicine can effectively reduce the pain score of sciatica caused by LDH and improve the score of motor function, and the curative effect is the same. 2. Compared with combined therapy, electro-acupuncture may be the lowest cost, and the best cost-effectiveness and cost-effectiveness therapy in the treatment of sciatica caused by LDH.
【學(xué)位授予單位】：成都中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號】：R246.6
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