英夫利西单抗在国内中等城市治疗中重度类风湿关节炎的成本效果  

Cost-effectiveness of Infliximab for the Treatment of Moderate or Severe Rheumatoid Arthritis in a Medium-sized City of China

作　　者：李敬扬[1] 田锋[1] 张靓[1] 何静芸 陈文东 

机构地区：[1]中南大学湘雅医学院附属株洲医院风湿免疫科,株洲412007 [2]长沙诺民医疗科技有限公司,长沙410008

出　　处：《中国医疗保险》2016年第10期49-53,共5页China Health Insurance

摘　　要：在中等城市株洲开展了一项前瞻性队列研究,比较英夫利西单抗和常规改善病情抗类风湿药物(c DMARD)治疗中重度类风湿关节炎的健康结果和直接医疗费用。以此研究结果为基础,采用基于马尔可夫模型的成本效果分析(CEA),模拟终生时间的英夫利西单抗和c DMARD组的生命质量调整年(QALY)、直接医疗费用和增量成本效果比(ICER)。成本效果分析结果表明,接受英夫利西单抗治疗能够比c DMARD治疗多获得7.982个QALYs,同时增加785,430元终生直接医疗费用。英夫利西单抗相对于c DMARD每增加一个QALY的费用为98,359元,合1.669倍2015年株洲市国内人均生产总值(GDPPC)。单因素敏感度分析显示变量浮动造成英夫利西单抗ICER浮动区间为0.882至3.157GDPPC。概率敏感度分析5000次模拟产生的ICER值95%置信区间为0.504至5.936 GDPPC。如果以3倍GDPPC/QALY作为意愿支付阈值,英夫利西单抗具有成本效果优势的概率为82.1%。研究结果显示,英夫利西单抗相对于c DMARD在国内中等城市治疗中重度类风湿关节炎的成本效果可接受。A prospective cohort study was conducted to compare the health outcomes and medical costs of infliximab and conventional disease modified anti-rheumatic drugs （cDMARD） for treatment of moderate or severe rheumatoid arthritis （RA） in patients living in Zhuzhou, a medium-sized city of China. A Markov-model based costeffectiveness analysis （CEA） was conducted to compare lifetime health benefits and direct medical costs associated with infliximab and cDMARD for quality-adjusted life year （QALY）, direct medical costs and incremental costeffectiveness ratio （ICER）. Base case analysis estimated that the infliximab treatment could provide additional 7.982 QALY and an increase of direct medical costs ￥785,430 when compared with cDMARD, the cost per QALY gain was ￥98,359, equal to 1.669 times of 2015 gross domestic products per capita （GDPPC） in Zhuzhou. One-way sensitivity analysis suggested that the uncertainty associated with each model variable could range the ICER from 0.882 to 3.157 GDPPC. Probabilistic sensitivity analyses with 5000 simulations projected a 95% credible interval of 0.504 to 5.936 GDPPC. At a wilJingness to pay threshold of 3 GDPPC per QALY, the probability of infliximab being cost-effective compared with cDMARDs was 82.1%. The cost-effectiveness of infliximab compared with cDMARD for patients with moderate or severe RA in medium-sized cities in China is acceptable.

关 键 词：类风湿关节炎 英夫利西单抗 成本效果 

分 类 号：R593.22[医药卫生—内科学]