贝前列腺素钠对比西洛他唑和沙格雷酯治疗下肢外周动脉闭塞的成本-效用

目的评价贝前列腺素钠分别对比西洛他唑和沙格雷酯在治疗外周动脉疾病(PAD)方面的经济效益,为PAD患者的治疗及医保支付提供循证决策依据。方法利用决策树模型,模拟6个月用药周期内的健康经济产出。模型结果产出包括直接医疗成本、生命质量调整年(QALYs),以及增量成本-效用比(ICUR)。临床疗效数据和患者医疗成本数据通过15位分布全国的PAD领域的临床专家访谈得到,其职称为副主任及以上;效用数据和药品价格分别通过已发表的文献和药品招标采购价格数据库获得;严重不良事件的分支概率进行了网状Meta分析和合理假设。最终对所有的模型参数进行单因素敏感分析和概率敏感性分析,以检测模型的稳健性。结果对于PAD患者,与西洛他唑比较,6个月贝前列腺素钠的治疗方案将会产生0.026 QALYs的健康获益,对应减少806元成本,即ICUR为-31 247元/QALYs;与沙格雷酯比较,贝前列腺素钠将会产生0.017 QALYs的健康获益,对应额外479元的成本产出,即ICUR结果为28 778元/QALYs。单因素敏感性分析显示,模型产出的ICUR值对药物的成本和严重不良事件处理成本最为敏感。概率敏感性分析结果显示,2000次迭代的ICUR均值与确定性结果误差小于5%;成本-效用可接受曲线显示,在一倍中国人均GDP的支付意愿阈值内,贝前列腺素钠的成本-效用有100%的概率占优。结论从中国医保支付的角度,与西洛他唑和沙格雷酯比较,贝前列腺素钠在治疗PAD上具有成本-效用优势。

Cost-utility of Beraprost Versus Cilostazol and Sargogrelate for the Treatment of Patients with Peripheral Artery Occlusion of Lower Extremities

Objective To assess the cost-utility of beraprost and cilostazol, sargogrelate for treatment of patients with symptomatic peripheral arterial disease(PAD). Methods The decision tree model was used to simulate the health economic output during the 6-month medication cycle. The outputs for this model were direct medical costs, quality adjusted life years(QALYs), and the incremental cost-utility ratios(ICURs). Clinical efficacy data and patient medical cost data were obtained through interviews with 15 clinical experts in the field of PAD distributed across the country, with the title of deputy director and above;utility data and drug prices were obtained through published literature and drug bidding procurement price database;serious The branch probabilities of adverse events were analyzed by a network Meta-analysis and reasonable assumptions. Finally, single-factor sensitivity analysis and probability sensitivity analysis were performed on all model parameters to detect the robustness of the model. Results For PAD patient, compared with cilostazol, six months of treatment with beraprost would yield total QALYs of 0.026 health benefits, corresponding to a reduction of the cost of 806 yuan, that was, ICUR was-31 247 yuan/QALYs;compared with sagrelate, beprostaglandin sodium would produce a health benefit of 0.017 QALYs, corresponding to an additional cost output of 479 yuan, that was the ICUR result was 28,778 yuan/QALYs. Single factor sensitivity analysis showed that the ICUR value produced by the model was most sensitive to the cost of drugs and the cost of handling serious adverse events. The results of probabilistic sensitivity analysis showed that the ICUR average value and the deterministic result of 2000 iterations had an error of less than 5%;the cost-utility acceptance curve showed that the cost of beprostaglandin sodium was within the willingness to pay threshold of one time China’s per capita GDP-the utility had a 100% probability of being dominant. Conclusion From the perspective of the national healthcare system in Chinese settings, compared with cilostazol and sagrelate, beprostaglandin sodium has a cost-efficacy advantage in the treatment of PAD.