中国新诊断癫痫儿童首选丙戊酸钠或左乙拉西坦治疗方案的成本效果分析  

A cost-effectiveness analysis of valproate and levetiracetam treatment in Chinese children with newly diagnosed epilepsy

作　　者：高静云[1] 王颖慧[1] 杨莉[2] 臧莉莉[1] 黄琼辉[1] 赵海娟[1] 王云秀[1] 王丽[1] 姜玉武[1] 吴晔[1] 

机构地区：[1]北京大学第一医院儿科,100034 [2]北京大学公共卫生学院

出　　处：《中华实用儿科临床杂志》2013年第1期42-47,共6页Chinese Journal of Applied Clinical Pediatrics

基　　金：首都医学发展基金（2009-2021）

摘　　要：目的对中国新诊断癫痫患儿首选丙戊酸钠（VPA）或左乙拉西坦（LEV）治疗方案进行成本效果分析，从药物经济学角度为抗癫痫药的个体化选择提供依据。方法利用决策树模型模拟新诊断的癫痫患儿VPA一线治疗或LEV一线治疗后的不同结局，总观察时间为6个月。LEV或VPA单药治疗3个月进行第1次疗效评估，根据评估结果调整药物（继续用原药、添加或换用VPA或LEV），再治疗3个月进行第2次疗效评估。分别获得VPA一线治疗或LEV一线治疗患儿6个月的治疗成本以及治疗效果，在决策树模型中进行成本效果分析。用增量成本效果比来反映2种治疗方案的效果和成本的综合比较，即一种治疗方案较另一种治疗方案多增加1例无发作病例所需要多支出的成本。结果对于中位数体质量的中国儿童，LEV一线治疗较VPA一线治疗每新增1例无发作病例，6个月需多支出4981．858元。如果6个月的意愿支付成本在4000元以上，则LEV一线治疗方案成本效果更好的可能性大。6个月的支付成本为25000元时，LEV一线治疗方案具有更好成本效果的概率为90％。结论低意愿支付成本的情况下，VPA一线治疗的成本效果更佳，高意愿支付成本的情况下，LEV一线治疗的成本效果更佳。在其他因素综合考虑的情况下，药物经济学因素应作为个体化药物选择的考虑指标之一。Objective To analyze the cost-effectiveness of valproate （VPA） or levetiracetam （LEV） for the first choice in children with newly diagnosed epilepsy, and to understand the pharmacoeconomics choice for anti-epileptic drugs in individual patient. Methods The differences were observed during 6 months treatment process in Chinese children with newly diagnosed epilepsy treated with VPA as the first line drug or LEV as the first line drug by decision tree model. The curative efficacy was evaluated for the first time at the end of 3 months in patients treated with LEV or VPA as monotherapy, and then the treatment strategy was adjusted according to the efficacy evaluation and adverse effects （ the first drug continued, added or replaced with VPA or LEV）. The second curative efficacy was evaluated after another 3 months of treatment. The effect and cost of 2 kinds of treatment strategies were compared by the incremental cost-effectiveness ratio （ICER） ,that was, the additional cost of pay for one more seizure-free case was compared between a kind of treatment and another treatment. Results For a Chinese child with median weight, additional 4981. 858 Yuan（RMB） was needed for the increase of each seizure-free case treated with LEV as the first line treatment drug compared with VPA as the first line treatment drug within 6 months. If patients were to pay 4000 Yuan within 6 months treatment,the cost-effectiveness of LEV as the first line treatment was probably better than that of VPA. If patients were to pay 25 000 Yuan within 6 months treatment, there could be 90% possibility of the former cost-effectiveness with LEV as the first line treatment. Conclusions If patients are unlikely to pay more, VPA as the first line treatment is better in cost -effectiveness than that of LEV. If patients are willing to pay, LEV as first line treatment drug is better in cost-effectiveness. Pharmacoeconomics factors, as well as other factors, should be considered in guiding the drug choice by the individual patient.

关 键 词：癫痫 成本效果分析 丙戊酸钠 左乙拉西坦 儿童 

分 类 号：R742.1[医药卫生—神经病学与精神病学]