生长抑素类似物治疗术后活动性肢端肥大症的成本效果分析  

Cost-effectiveness analysis of octreotide long acting release and lanreotide slow release for the treatment of postoperative patients with active acromegaly in China

作　　者：宣建伟 张朝云[2] 王镛斐[3] 毛志钢[4] 卢永吉 王任直[6] 

机构地区：[1]中山大学药学院医药经济研究所,广州510085 [2]复旦大学附属华山医院内分泌科 [3]复旦大学附属华山医院神经外科 [4]中山大学附属第一医院神经外科 [5]上海盛特尼医药科技有限公司 [6]中国医学科学院北京协和医学院北京协和医院神经外科

出　　处：《中华医学杂志》2017年第10期765-769,共5页National Medical Journal of China

摘　　要：目的运用成本效果研究方法，评价长效奥曲肽及兰瑞肽治疗术后生化指标未达标的肢端肥大症患者的经济性。方法建立决策树模型，模拟术后生化指标未达标患者治疗流程，长效奥曲肽和兰瑞肽2个治疗组，模型设定每组1 000例，观察期1年。通过文献复习获取临床疗效的数据，通过临床专家问卷调查及病历回顾，获得治疗流程及成本数据，纳入模型中进行成本效果分析。结果长效奥曲肽相对兰瑞肽，胰岛素样生长因子1（IGF－1）、生长激素（GH）控制达标率分别高10%和9%，因此并发症发生及需要接受放疗、二次手术的人数均比兰瑞肽组少。当以IGF－1作为效果指标时，长效奥曲肽具有更好的疗效及更低的总费用（1年观察期总费用比兰瑞肽低3 792元/人），具有成本效果优势。当以GH作为效果指标时，长效奥曲肽疗效更好，但总费用略高（1年观察期总费用比兰瑞肽高4 121元/人）。结论长效奥曲肽较好的生化控制达标率使得肢端肥大症患者并发症发生率较低，需要二次手术、放疗的人数减少，从而使其并发症治疗和手术、放疗的医疗费用均低于兰瑞肽组。ObjectiveTo evaluate the cost-effectiveness of octreotide long acting release （LAR） vs lanreotide slow release （SR） for the treatment of postoperative acromegalic patients with elevated levels of growth hormone （GH） and insulin-like growth factor 1 （IGF-1） in China. MethodsA decision tree model was constructed and the treatment impact was projected for one year in Chinese setting. The clinical efficacy measure used was the percentage of patients achieving normalization （control） of either IGF-1 or GH levels. Efficacy of octreotide LAR and lanreotide SR, incidence of comorbidities, impact of acromegaly on health-related quality of life, and drug-related side effects data were obtained from literature. The cost of medication was collected through a chart review from five hospitals in five cities of China. Clinical experts from these hospitals were requested to complete a questionnaire to document the utilization of medical resources, costs of comorbidities, side effects as well as cost of administration. One-way sensitivity analysis was performed to evaluate the robustness of the results. ResultsCompared to lanreotied SR group, the percentage of patients achieving normalization of IGF-1 and GH levels of octreotide LAR group were 10% and 9% higher, respectively. When either IGF-1 or GH control were used as the efficacy measure, patients in the octreotide LAR group exhibit less comorbidities and need less continued treatment with a second operation and radiotherapy than those in lanreotide SR group. When IGF-1 was used as efficacy measure, octreotide LAR not only achieved better efficacy but resulted in overall cost-saving, with a total cost savings of ￥ 3 792 per patient for one year, which demonstrated that octreotide LAR was a dominant cost-saving strategy. When GH control was used as the efficacy measure, octreotide LAR achieved a better overall clinical efficacy with a slightly higher total costs （￥ 4 121 higher per patient per year）. Sensitivity analysis didn′t change the con

关 键 词：肢端肥大症 药物疗法 成本效果分析 生长抑素类似物 

分 类 号：R584.11[医药卫生—内分泌]