目的:评价两种他克莫司初始治疗方案治疗特发性膜性肾病(idiopathic membranous nephropathy,IMN)的经济性,以期用最低成本获得最佳的治疗效果.方法:采用药物经济学评价方法并引入决策树模型,选取2014年11月—2016年6月滨州医学院附属医院诊断为IMN的患者125例,根据他克莫司给药前是否进行其代谢相关基因(CYP3A5*3)检测分为他克莫司常规给药组(68例)和他克莫司给药前基因检测组(57例),对两组治疗方案进行成本-效果分析;以多属性效用理论(multi-attribute utility theory,MAUT)分析有效率、治疗费用、剂量调整时间(d)及不良反应等因素对治疗方案选择的影响.结果:两组治疗方案有效率的差异无统计学意义(P>0.05);他克莫司给药前基因检测组治疗方案的成本-效果比低于他克莫司常规给药组治疗方案;MAUT分析结果显示,他克莫司给药前基因检测组治疗方案得分高于他克莫司常规给药组治疗方案.结论:成本-效果分析和MAUT分析结果均显示,在IMN的初始治疗方面,他克莫司给药前进行基因检测的方案优于他克莫司常规给药方案.%OBJECTIVE:To evaluate the economical efficiency of two primary therapeutic regimens of tacrolimus in treatment of idiopathic membranous nephropathy ( IMN) , in order to obtain the best therapeutic effects with the least cost.METHODS:Pharmacoeconomics evaluation and decision tree model were adopted , 125 patients diagnosed IMN in the Affiliated Hospital of Binzhen Medical University from Nov .2014 to Jun.2016 were selected and divided into conventional administration group (68 cases) and pre-administration genetic detection group (57 cases) according to if the metabolism related genetic detection ( CYP3 A5*3 ) was conducted before the administration of tacrolimus , cost-effectiveness analysis was proceeded on the two therapeutic regimens;multi-attribute utility theory ( MAUT) was used for analyzing the effect of effective rates , therapy costs , dose adjustment times and incidences of adverse drug reactions on the selection of therapeutic regimen .RESULTS:There was no statistical significance in the effective rates between two therapeutic regimens ( P>0.05 ); the cost-effectiveness ratio of pre-administration genetic detection group was lower than that of the conventional administration group;results of MAUT analysis showed that the pre-administration genetic detection group scored higher than that of the conventional administration group .CONCLUSIONS: Results of cost-effectiveness analysis and MAUT analysis both show that the primary therapeutic regimen of pre-administration genetic detection is better than conventional administration in treatment of IMN .
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