| ObjectiveChronic obstructive pulmonary disease(COPD)is characterized by a long course of disease,prone to recurrent attacks and even progressive exacerbations.Because COPD patients need long-term medication,resulting in a heavy burden of personal and social diseases,it has become the second largest respiratory disease.Although clinical guidelines recommend the treatment drugs of COPD,the clinical drug use was actually more complicated and caused the different effects.To evaluate the therapeutic efficacy and short-term pharmacoeconomics of Budesonide Formoterol,Salmeterol Ticasone and Tiotropium Bromide during hospital admission for acute COPD exacerbations,the cost-effect analysis and a Markov model to predict the disease burden for five years was established in this study.The result of study would provide a basis for health decision-making with more appropriate treatment measures,and more suitable economic burden of patients.MethodsObservational study were designed in this study.Inpatients with acute exacerbation chronic obstructive pulmonary disease(COPD)were included from 2016 to 2021 in Affliciate Hospital of Shenyang Meidcal College.According to medication regimen,patients were divided into Budesonide Formoterol,Salmeterol Ticasone and Tiotropium Bromide.Clinical data and hospitalization expenses were collected by HIS system as the evaluation index of clinical treatment effect to evaluate the short-term treatment effects of patients in different treatment plan groups during hospitalization.The total hospitalization expenses were taken as the cost and cost-effectiveness analysis was used to evaluate the health economics effects of different drugs.In order to further explore the economic effects of long-term medication in COPD patients,Markov model was established,with drug costs and total hospitalization costs as cost indexes and quality-adjusted life years(QALYs)as health outcomes indexes,to simulate and predict the five-year disease burden in COPD patients with different outcomes.EXCEL database was established to collect and sort out clinical data of patients during hospitalization,and statistical analysis and comparison were conducted using SPSS22.0.Measurement data were expressed by mean ± standard deviations((?)),The statistical data were represented by the number of cases(n)and percentage(%).one-way ANOVA was used for between-group comparisons,and two-sample paired t-test was used for comparison before and after treatment within the group,P<0.05,a=0.05.The TreeAge Pro 2011 software was used to establish the Markov model,and the five-year disease burden prediction was predicted by multiplicative analysis and cohort simulation methods,and the incremental cost-effect ratio was used as the evaluation index,and the robustness of the test results was tested by unvariate sensitivity.Results1.A total of 530 patients with acute exacerbation were included in this study,including 277 males(52.3%)and 253 females(47.7%);Average age was 73.40±10.48 years;The average length of hospitalization was 10.85±4.59 days;there were 202 persons(38.1%)of non-smokers,191(36.0%)were smokers,and 137(25.9%)were former smokers.According to the severity of illness,there were 419 patients(79.1%)in Grade Ⅰ,75 patients(14.1%)in Grade Ⅱ,and 36 patients(6.8%)in Grade Ⅲ.According to drug use,231 patients were assigned to Budesonide Formoterol group,198 to Salmeterol Ticasone group,and 101 to Tiotropium Bromide group.Among the basic information,there was statistical significance in age difference among the three groups(P=0.025),while there was no statistical difference in other indicators(P>0.05).The characteristics of patients were similar.2.In the intra-group comparison before and after treatment,blood gas analysis and C-reactive protein of all levels of patients in the three treatment groups were improved among different degrees.There was no significant difference in PaCO2 before and after treatment in Grade Ⅰ patients(P>0.05),while PaO2 and C-reactive Protein were significantly improved(P<0.01).In Grade Ⅱ patients,there was statistical significance in the Budesonide Formoterol treatment group(P<0.05),and there was significant improvement in the three PaO2 treatment groups(P<0.01).There was statistical significance in the difference between Budesonide Formoterol and Salmeterol Ticasone in C-reactive Protein before and after treatment(P<0.05).There was no statistical significance in Tiotropium Bromide treatment group(P>0.05).Blood gas analysis of Grade Ⅲ patients with PaCO2 and PaO2 showed statistical significance in the Budesonide Formoterol treatment groups(P<0.05),although C-reactive protein was improved to some extent in the three treatment groups,there was no statistical significance before and after treatment(P>0.05).3.Compared between groups after treatment,PaCO2 in Grade Ⅲ patients after treatment was statistically significant(P<0.05),while there was no statistically significant difference in laboratory indexes of other patients at all levels among the three groups after treatment(P>0.05).Improvement value of laboratory indexes PaO2 was statistically significant in Grade Ⅲ patients after treatment(P<0.05),while there was no significant difference in improvement value of laboratory indexes in other levels of patients in Budesonide Formoterol,Salmeterol Ticasone and Tiotropium Bromide groups(P>0.05).4.Pharmacoeconomic analysis showed that the cost-effectiveness ratio of Budesonide Formoterol in PaCO2 and PaO2 improvement in Grade I patients was the lowest,which was 40628.41 RMB and 1501.48 RMB,respectively.Salmeterol Ticasone had the lowest cost-effectiveness ratio(557.52 RMB)in C-reactive Protein improvement.Budesonide Formoterol had the lowest cost-effectiveness ratios in PaCO2 and C-reactive Protein improvement in Grade Ⅱ patients,which were 2494.00 RMB and 492.31 RMB,respectively.In PaO2 improvement,the cost-effectiveness ratio of Salmeterol Ticasone was the lowest(742.96 RMB).In terms of PaCO2 improvement in Grade Ⅲ patients,the cost-effectiveness ratio of Salmeterol Ticasone was the lowest(1030.78 RMB),showing the most economic advantage.In PaO2 improvement,the cost-effectiveness ratio of Budesonide Formoterol was the lowest(613.21 RMB).The cost-effectiveness ratio of Tiotropium Bromide for C-reactive Protein improvement was the lowest(996.00 RMB).5.The 5-year regression analysis results of Markov model showed that the cost-effectiveness ratio of Budesonide Formoterol was 5835.87/QALY,the cost-effectiveness ratio of Salmeterol Ticasone and Tiotropium Bromide was 6016.91/QALY and 5697.84/QALY respectively.Baseline analysis showed that compared with Tiotropium Bromide,the incremental cost-effectiveness ratio of Salmeterol Ticasone was negative,indicating that Salmeterol Ticasone was more economical.Budesonide Formoterol compared Tiotropium Bromide.Although the regression analysis results showed that the cost-effect ratio of Tiotropium Bromide was lower,the incremental cost-effect was 12847.72,which was less than RMB 81370 per capita GDP,indicating that the cost of Budesonide Formoterol was worthwhile under the threshold standard of the willingness to pay at 1 times GDP per capita.Budesonide Formoterol has an economic advantage.The results of unary sensitivity analysis showed that the results of Budesonide Formoterol were robust in a large probability range,and the tornado map showed that the QALYs of stable period,the cost of BFC stable period,the cost of BFC acute exacerbation period and the QALYs of acute exacerbation period were the four factors that had the greatest influence on the results.Conclusion1.Blood gas analysis and C-reactive protein of all levels of patients in the three treatment groups were improved to different degrees of COPD inpatients,and the clinical efficacy of Salmeterol Ticasone and Tiotropium Bromide were similar;With the increase of disease severity,Budesonide Formoterol improved blood gas analysis more obviously.2.Short-term pharmacoeconomic analysis among the inpatients with acute COPD exacerbation showed that Budesonide Formoterol had a good economic advantage in improving blood gas analysis(PaCO2 and PaO2)in Grade Ⅰ and Ⅱpatients.3.The resluts of five-year disease burden prediction for Markov model with COPD stable period suggested that the cost-effectiveness ratio of Tiotropium Bromide is the lowest.From the perspective of health care system,the cost-effectiveness analysis results showed that Budesonide Formoterol has an economic advantage under the threshold of 1 times GDP per capita willingness to pay. |
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