塞来昔布用于治疗中国骨关节炎疼痛的短期成本-效用

目的探讨塞来昔布、布洛芬和萘普生在中国骨关节炎(osteoarthritis, OA)疼痛治疗中的短期成本-效用。方法基于医保支付方的角度,采用已公开发表的基于英国国家卫生和临床技术优化研究所(NICE)骨关节炎指南研发的半马尔科夫模型,模拟为期1年塞来昔布、布洛芬和萘普生在OA治疗中的健康产出和成本。模型中转移概率来源于PRECISION随机对照临床研究,成本数据包括公开的中国本土药品费用、不良反应事件治疗费用及后续治疗费用数据。结果在1年的OA患者治疗中,相比于布洛芬,塞来昔布生命年和质量调整生命年分别提高了0.001年、0.001QALYs,直接医疗费用、药费、3种不良反应事件(AEs)治疗及其后续治疗成本分别降低了576.43元、424.72元、138.09元、13.62元,增量成本-效用比(ICUR)值为-419 182元/QALY。与萘普生比较,OA患者接受为期一年的塞来昔布治疗生命年和质量调整生命年分别提高了0.001年、0.001 QALYs,直接医疗费用、药费、3种AEs治疗及其后续治疗成本分别降低了490.09元、433.52元、53.41元、3.17元,ICUR值为-568 039元/QALY。因此相比于布洛芬与萘普生,塞来昔布在短期治疗OA为绝对优势方案。单因素敏感性分析表明基础分析结果稳健。结论在中国OA患者为期1年治疗中,与布洛芬和萘普生比较,塞来昔布能延长OA患者的生命年,提高生命质量并节约成本,是具有成本-效用的方案。

Short-term Cost Utility of Celecoxib in Treatment of Osteoarthritis Pain in China

Objective To explore the short-term cost-utility of celecoxib, ibuprofen and naproxen in the treatment of osteoarthritis pain in China. Methods From the payer perspective, the published semi-Markov model based on the National Institute of Health and Clinical Technology Optimization(NICE) Osteoarthritis Guidelines was used to simulate celecoxib, ibuprofen and naproxen in the treatment of OA for a period of one year health output and cost. The transition probability in the model came from a PRECISION randomized controlled clinical study, and the cost data included publicly available Chinese local drug costs, treatment costs for adverse events and subsequent treatment costs. Results In the one-year treatment of OA patients, compared to ibuprofen group, the life years(LYs) gained and quality-adjusted life years(QALYs) gained of the celecoxib group yielded an additional 0.001 years and 0.001 QALYs. Moreover, the direct medical cost, cost of medicine, the treatment of 3 types of adverse events and their subsequent treatment cost were reduced by 576.43 RMB, 424.72 RMB, 138.09 RMB, and 13.62 RMB respectively. The corresponding incremental cost-utility ratio(ICUR) was-419 182 RMB/QALY. Compared with naproxen group, the life-year and quality-adjusted life-year of patients with OA who received the one-year celecoxib treatment increased by 0.001 year and 0.001 QALYs respectively, and the direct medical expenses, drug costs, 3 kinds of AEs treatment and subsequent treatment costs were reduced by 490.09 yuan, respectively. 433.52 yuan, 53.41 yuan, 3.17 yuan, ICUR value-568 039 yuan/QALY. Therefore, compared with ibuprofen and naproxen, celecoxib was an absolute advantage in the short-term treatment of OA. Single factor sensitivity analysis showed that the basic analysis results were robust. Conclusion During the one-year treatment of OA patients in China, compared with ibuprofen and naproxen, celecoxib can prolong the life years of patients with OA, improve the quality of life and save costs, which is a cost-utility solution.