肾炎康复片联合西医常规治疗糖尿病肾病的药物经济学研究  

Pharmacoeconomic evaluation of Shenyankangfu tablets plus conventional therapy in treating diabetic ephropathy

作　　者：官海静[1,2] 韩晟[1,3] 王雅楠[2] 李成明 郑丽英[3] 史录文[1,3] GUAN Hai-jing HAN Sheng WANG Ya-nan LI Cheng-ming ZHENG Li-ying SHI Lu-wen(Peking University School of Pharmaceutical Sciences, Beijing 100191, China International Research Center of Medicinal Administration Peking University, Beijing 100191, China China Center for Health Economic Research, Peking University, Beijing 100871, China School of Software ＆ Microelectronics, Peking University, Beijing 102600, China)

机构地区：[1]北京大学药学院,北京100191 [2]北京大学中国卫生经济研究中心,北京100871 [3]北京大学医药管理国际研究中心,北京100191 [4]北京大学软件与微电子学院,北京102600

出　　处：《中国新药杂志》2017年第20期2491-2496,共6页Chinese Journal of New Drugs

基　　金：国家"重大新药创制"科技重大专项资助项目(2014ZX09201021-007)

摘　　要：目的:对肾炎康复片治疗糖尿病肾病的短期和长期经济性进行评价。方法:基于支付方角度,采用循证药物经济学评价方法,分析肾炎康复片联合西医常规治疗相比单用西医常规治疗的成本效果。在短期分析中,效果(血清肌酐、尿素氮、24 h蛋白尿定量)来源于现有的临床文献,成本数据基于药品中标价和DDD计算得到。在长期分析中,Markov模型参数来源于现有临床、经济学文献和离散事件仿真模拟,循环周期为1个月,模拟患者终身的直接医疗费用和质量调整生命年。采用单因素敏感性分析和概率敏感性分析评价结果的稳健性。结果:短期经济性分析显示,与西医常规治疗相比,肾炎康复片联合常规治疗的费用更高,效果更好,由于缺乏标准阈值,不能判断其经济性。长期经济性分析显示,肾炎康复片联合常规治疗组的终身费用为43.27万元,质量调整生命年为4.91 QALYs;常规治疗组的终身费用为41.22万元,质量调整生命年为4.44 QALYs。两组的增量成本-效用比为43 341元,小于2016年中国人均GDP 53 980元,说明肾炎康复片联合西医常规治疗具有经济性。敏感性分析表明了结果的稳健性。结论:从长期来看,与单纯西医常规治疗相比,肾炎康复片联合常规治疗组治疗糖尿病肾病具有经济性。Objective： To evaluate the economics of Shenyankangfu （SYKF） tablets in treating diabetic nephropathy.Methods： Evidence-based pharmacoeconomic evaluation method was adopted,using data from published randomized clinical trials and epidemiological and cost studies,to evaluate the economics of SYKF tablets from the payer perspective,in both short-and long-term.In the short-term analysis,the effectiveness indexes （Scr,BUN,24 h proteinuria quantification） came from published RCTs,and the cost was calculated using DDD and average binding price of SYKF tablets.In the long-term analysis,we used a Markov model to simulate the cost and quality of life gained during the patients＇ life time.Markov model parameters came from published literature and discrete event simulation （DES）.Model cycle was one month.One-way and probabilistic sensitivity analysis was used to check the robustness.Results： As the short-term analysis shown,compared with conventional treatment （CT）,SYKF tablets plus CT had better effectiveness and higher expenditure.Due to lacking of threshold,the economical efficiency of the treatment couldn＇t be estimated.Markov model cohort analysis showed that in the SYKF group,the patients could acquire 4.91 QALYs with 0.432 7 million yuan while the conventional group would benefit 4.44 QALYs with 0.412 2 million yuan.The incremental cost-utility ratio （ICUR） of the two groups was 43341 yuan per QALYs,less than the GDP per capita （53 980 yuan）.The sensitive analysis showed that the analysis result was robust.Conclusion： Compared with the conventional single Western medicine treatment,SYKF-Western medicine combination therapy may be a better choice in the long run.

关 键 词：糖尿病肾病 肾炎康复片 药物经济学评价 MARKOV模型 

分 类 号：R95[医药卫生—药学]