Cost-effectiveness analysis of Biyuan Tongqiao Granules combined with Triamcinolone Acetonide Nasal Spray in treatment of chronic rhinosinusitis / 中国中药杂志

This study aims to evaluate the effectiveness and economic efficiency of Biyuan Tongqiao Granules combined with Triamcinolone Acetonide Nasal Spray in the treatment of chronic rhinosinusitis(CRS). The randomized controlled trial(RCT) of Biyuan Tongqiao Granules combined with Triamcinolone Acetonide Nasal Spray in the treatment of CRS was searched against EMbase, PubMed, Cochrane Library, CNKI, VIP, SinoMed, and Wanfang. The efficacy, nasal mucociliary transport time, and safety of the therapy above in the treatment of CRS were analyzed with single-group rate and Meta-analysis, and the economy and sensitivity were evaluated from the perspective of payer. A total of 9 RCTs were included, including 1 145 patients. Meta-analysis showed that compared with Triamcinolone Acetonide Nasal Spray alone, Biyuan Tongqiao Granules combined with Triamcinolone Acetonide Nasal Spray in the treatment of CRS patients increased the effective rate(RR=1.17, 95%CI[1.11, 1.24], P<0.000 01) and shortened the nasal mucociliary transport time(MD=-3.32, 95%CI[-5.86,-0.78], P=0.01), there was no significant difference in the incidence of adverse reactions between the two groups. The incremental cost-effectiveness analysis showed that the treatment costs of the control group and the observation group were 44.15 yuan and 1 044.96 yuan, respectively. In the Biyuan Tongqiao Granules combined with Triamcinolone Acetonide Nasal Spray treatment group, 75.48 yuan was spent to improve the effective rate of CRS by 1%. The one-way sensitivity analysis indicated the days of treatment, the RR of Biyuan Tongqiao Granules combined with Triamcinolone Acetonide Nasal Spray, the price of unit preparation of Biyuan Tongqiao Granules, and the effective rate of Triamcinolone Acetonide Nasal Spray alone had great influence on the incremental cost-effectiveness ratio. In conclusion, Biyuan Tongqiao Granules combined with Triamcinolone Acetonide Nasal Spray improves the therapeutic effect on CRS. The probabilistic sensitivity analysis showed that when the willingness to pay was greater than 7 920 yuan(less than 0.1 of GDP per capita 8 098 yuan), the combined therapy was economically superior to the control. Due to the limited number of articles published, it is necessary to carry out a real-world clinical trial of Biyuan Tongqiao Gra-nules and Triamcinolone Acetonide Nasal Spray in the treatment of CRS, so as to compare the cost-effectiveness of Biyuan Tongqiao Granules and Triamcinolone Acetonide Nasal Spray.

Efficacy of Yiqi-Tuomin decoction combined with triamcinolone acetonide nasal spray on allergic rhinitis and its effect on Th1/Th2 balance / 国际中医中药杂志

Objective To investigate the effect of Yiqi-Tuomin decoction combined with triamcinolone acetonide nasal spray on Th1/Th2 balance in allergic rhinitis (AR) and to observe the clinical efficacy.Methods A total of 100 patients who met the inclusion criteria were divided into two groups by random number table method,50 in each group.The control group was treated with triamcinolone acetonide nasal spray.The observation group was given Yiqi-Tuomin decoction on the basis of the control group.Both groups were treated for 4 weeks and followed up for 3 months.Clinical symptom score was performed before and after treatment.The serum level of interferon-γ (IFN-γ) and IL-4 was detected by ELISA,and the ratio of IFN-γ/IL-4 was calculated.The adverse reaction and recurrence rate during treatment was observed and recorded,and the clinical efficacy was evaluated.Results The total effective rate was 94.0％ (47/50) in the observation group and 80.0％ (40/50) in the control group.There was significant difference between the two groups (x2=4.332,P=0.037).After treatment,the serum IFN-γ (95.15 ± 18.49 ng/L vs.83.85 ± 16.20 ng/L,t=3.250) and the ratio of IFN-γ/IL-4 (1.35 ± 0.21 vs.0.93 ± 0.19,t=5.878) significantly increased (P＜0.01),while serum level of IL-4 (71.14 ± 14.15 ng/L vs.89.8 6 ± 17.52 ng/L,t=10.487) significantly decreased in the observation group (P＜0.01).After treatment,the score of nasal obstruction,rhinocnesmus,sneezing and nasal discharge in the observation group were significantly lower than those in the control group (t=11.229,8.921,8.253,10.464,respectively,all Ps＜0.01).Conclusions The Yiqi-Tuomin decoction combined with triamcinolone acetonide nasal spray can significantly improve the clinical symptoms of AR patients,correct the imbalance of Th1/Th2 ratio and improve the immunity of the body.

Efficacy and Safety of Biyuan Tongqiao Granules Combined with Triamcinolone Acetonide Nasal Spray versus Triamcinolone Acetonide Nasal Spray in the Treatment of Chronic Rhinosinusitis ：A Meta-analysis and Trial Sequential Analysis / 中国药房

OBJECTIVE： To systematically evaluate clinical efficacy and safety of Biyuan tongqiao granules combined with Triamcinolone acetonide nasal spray in the treatment of chronic rhinosinusitis， and to provide evidence-based reference for clinical treatment. METHODS： Retrieved from Embase， PubMed， the Cochrane library， CNKI， CBM， VIP and Wanfang database， RCTs about Biyuan tongqiao granules combined with Triamcinolone acetonide nasal spray （trial group） versus Triamcinolone acetonide nasal spray （control group） in the treatment of chronic rhinosinusitis were collected during database establishment to Dec. 8th， 2018. After data extraction and quality evaluation with Cochrane bias risk evaluation tool 5.1.0， Meta-analysis was performed for total response rate， nasal mucociliary transmission rate （MTR）， the levels of IL-5 and IL-8 in nasal secretion， SNOT-20 score， VAS score， Lund-Mackey nasal sinus CT score， the incidence of ADR （nausea， rash） by using Rev Man 5.3 software. TSA 0.9 software was used for trial sequential analysis（TSA）. RESULTS： A total of 9 RCTs were included， involving 998 patients. Results of Meta-analysis showed that total clinical response rate [RR＝1.20，95％CI（1.14，1.26），P＜0.001] of trial group was significantly higher than that of control group； MTR [MD＝－231.74，95％CI（－291.89，－171.58），P＜0.001]， IL-5 [MD＝－0.86，95％CI（－1.37， －0.35），P＜0.001] and IL-8 [MD＝－0.50，95％CI（－0.76， －0.25），P＜0.001] levels of trial group were significantly lower than those of control group. SNOT-20 score， VAS score and Lund-Mackey nasal sinus CT score of trial group were all lower than those of control group， with statistical significance （P＜0.001）. There was no statistical significance in the incidence of nausea [RR＝0.57，95％CI（0.17，1.92），P＝0.37] or rash [RR＝2.25，95％CI（0.70，7.20），P＝0.17] between 2 groups. TSA analysis showed that the evidence for therapeutic efficacy of Biyuan tongqiao granules combined with Triamcinolone acetonide nasal spray in the treatment of chronic rhinosinusitis was reliable. CONCLUSIONS： Biyuan tongqiao granules combined with Triamcinolone acetonide nasal spray is better than Triamcinolone acetonide nasal spray alone in improving total response rate of Biyuan tongqiao granules combined with Triamcinolone acetonide nasal spray in the treatment of chronic rhinosinusitis， reducing MTR， the levels of IL-5 and IL-8， and improving SNOT-20 score， VAS score and Lund-Mackey nasal sinus CT score， without increasing the incidence of nausea， rash.