Application Of Efficiency Frontier In The Selection Of Essential Medicines

Objective:To explore the application of efficiency frontier on the selection of essential drugs,taking the drug treatments of chronic urticaria for example.In order to offer a reference for the selection of essential drugs,to supply a quantitative reference for the drug prices and to provide evidence to support the distribution of health resource.Methods:Taking the literature research to retrieval Pubmed,Cochrane,OVID,Springer,CNKI,Wanfang,VIP and CBM database,based on the inclusion and exclusion criteria to screen the randomized controlled trials of the treatment for chronic urticarial,and evaluate the quality of the literatures;Using Bayesian net Meta-analysis to perform the evaluation of the effectiveness and safety of drugs,according to the probability distribution of the evaluation results to sort the 12 kinds of drugs;Taking Free Disposal Hull(FDH)and Data Envelopment Analysis(DEA)for the input-output efficiency analysis of included 12 kinds of drugs and constructing the efficiency frontier.Contents:Building the Bayesian Meta-analysis model for the efficacy and safety assessment of 12 kinds of drug treatments of chronic urticaria;Taking cost-effectiveness analysis to achieve economic evaluation of the drugs;Based on the above evaluation results,applying FDH and DEA model to construct the efficiency frontier of the therapeutic regimens for chronic urticariaResults:Through Bayesian Meta-analysis of the 12 kinds of drugs for treating chronic urticaria,the sorting results of efficiency evaluation showed that Clemastine Fumarate>Desloratadine Citrate Disodium Tablets>Epinastine Hydrochloride Tablets>Ebastine>Fexofenadine Hydrochloride Tablets>Desloratadine>Levocetirizine Hydrochoride Tablets>Mizolastine>Cetirizine Hydrochloride>Loratadine>Bepotastine Besilate Tablets>Xiao Feng Zhi Yang Ke Li;The sorting results of safety evaluation showed as follows:Xiao Feng Zhi Yang Ke Li>Ebastine>Epinastine Hydrochloride Tablets>Fexofenadine Hydrochloride Tablets>Desloratadine Citrate Disodium Tablets>Desloratadine>Bepotastine Besilate Tablets>Levocetirizine Hydrochoride Tablets>Mizolastine>Clemastine Fumarate>Loratadine>Cetirizine Hydrochloride.Collecting the total cost of 12 kinds of drugs,the results of economic analysis showed in order Levocetirizine Hydrochoride Tablets>Clemastine Fumarate>Cetirizine Hydrochloride>Loratadine>Ebastine>Mizolastine>Fexofenadine Hydrochloride Tablets>Desloratadine>Bepotastine Besilate Tablets>Epinastine Hydrochloride Tablets>Xiao Feng Zhi Yang Ke Li>Desloratadine Citrate Disodium Tablets.Taking the total drug cost as inputs,the results of efficacy or safety evaluation as outputs,the efficacy evaluation results of FDH model showed that Clemastine Fumarate and Levocetirizine Hydrochoride Tablets were on the efficiency frontier;the results of safety evaluation showed that Xiao Feng Zhi Yang Ke Li,Ebastine and Levocetirizine Hydrochoride Tablets were on the efficiency frontier.The efficacy evaluation results of DEA model showed that Clemastine Fumarate was on the efficiency frontier;safety evaluation showed that only Ebastine on it.The comprehensive efficiency evaluation of DEA model showed that the drugs on the efficiency frontier were Clemastine Fumarate and Ebastine.Conclusions:Efficiency frontier analysis of comprehensive evaluation of multi-drug treatment of chronic urticarial could not only combine the evidence-based medicine with pharmacoeconomic,but also achieve the combination of all three(efficiency,economic and safety).According to the sort of input and output efficiency,a reference for the clinical rational drug use and selection of essential drugs was drawn.In the application of efficiency frontier research,we should fully listen to the opinions and Suggestions of the experts in the fields of evidence-based medicine,clinical medicine,pharmacy and pharmacoeconomic.In the selection of studies,we should try to use high quality literature research results,large sample of medical cost data and safety monitoring data to ensure the stability and reliability of the research.