Evaluation Of Clinical Application And Evidence-based Research On The Volume-based Procurement Drug Levetiracetam

ObjectiveOn the one hand,this study was based on the patient’s prescription data in the real diagnosis and treatment environment to compare the clinical application of the successful bidding drug levetiracetam(LEV)tablet Jiyike and the brand drug Keppra in the treatment of epilepsy,and explored the clinical evaluation model of centralized procurement of drugs,while provided evidence for the clinical rational use of drugs.On the other hand,the published prospective clinical studies were systematically reviewed to compare intravenous LEV and Phenytoin(PHT)in the treatment of benzodiazepine-type refractory status epilepticus(SE).To comprehensively evaluate the efficacy and safety of SE patients provide evidence-based evidence for promoting more reasonable clinical applications.MethodsThe clinical application study extracts the prescription data of all patients using LEV from Xuanwu Hospital from March 23,2018 to January 31,2019(before volume-based procurement)and from March 23,2019 to January 31,2020(after volume-based procurement).Using SPSS 22.0 software to correct the baseline between the two groups of patients according to the matching tolerance of 0.1,matching ratio 1:1 nearest neighbor matching method,so that the baselines of the two groups of patients were comparable.After matching,through statistical analysis of indicators such as medication possession ratio and continuous single-drug use rate,after evaluating the quantity,the winning standard drug Jiyike is compared with the original drug Keppra.The clinical application and economics of the patient,the patient’s diagnosis and treatment behavior and the changes in the diagnosis and treatment cost before and after the amount.The measurement data of the matched samples are analyzed by t-test and the categorical variables are analyzed by chi-square test.The meta-analysis was through searched the following databases from inception up to July 17,2020: Pub Med,Web of Science,Cochrane Library,Embase,China National Knowledge Infrastructure,Wanfang Database,Sino Med Database,Weipu Database.A published prospective randomized controlled trial(RCT)of intravenous LEV(the control group was intravenous PHT)in the treatment of SE was included.The data that met the inclusion criteria for this study were extracted and systematic analyzed using Rev Man 5.3 and STATA 14.0 software.ResultsThrough propensity score matching,1446 patients in the Keppra group and the Jiyike group were included in the analysis,there were no differences in the single-drug use rate,medication possession ratio,≥80% medication possession ratio,and 3-month continuous treatment rate between the two groups.The abnormal increase rate of continuous treatment dose and the 6-month、9-month continuous treatment rate in Jiyike group was significantly lower than that of Keppra group.A total of 2976 pairs of patient data were included before and after volume-based procurement group and treatment behavior and the comparison of changes in diagnosis and treatment costs.there was no statistical difference in the single-drug use rate,medication possession ratio,≥80% medication possession ratio,the 3-month、6-month、9-month continuous treatment rate and the abnormal increase rate of continuous treatment dose.In addition,the average annual drug cost and the average defined daily cost(DDC)of the Jiyike group were significantly lower than those of the Keppra group,the average annual drug cost and DDC value per capita after volume-based procurement are significantly lower than those before volume-based procurement.The meta-analysis finally included 11 RCTs with a total of 1933 patients.Meta-analysis showed that the combined RR of clinical seizure control within 60 minutes was 1.08(95% CI: 1.02-1.14,P=0.01).The clinical recurrence rate RR within 24 hours was 1.03(95% CI: 0.66-1.59,P=0.91).The combined RR of AE was 0.83(95% CI: 0.57-1.21,P=0.34).The combined RR of life-threatening hypotension and acute respiratory depression was 0.29(95% CI: 0.10-0.81,P=0.02)and 0.63(95% CI: 0.40-0.98,P=0.04),respectively.Conclusion(1)In this study,there was no statistical difference in the other indicators except for the 6-month and 9-month continuous treatment rate of Jiyike and Keppra.In addition,the use of Jiyike can significantly reduce the cost of medicines for patients with epilepsy.(2)Levetiracetam is more effective than phenytoin for the treatment of benzodiazepine-type refractory SE and is associated with a lower incidence of more serious adverse events.