乌司他丁在体外循环心外科手术围手术期内应用的药物经济学评价  

Pharmacoecononic Evaluation of Administrating Ulinastatin in Perioperative Period of Cardiac Surgery with Cardiopulmonary Bypass

作　　者：林子义 熊卫萍[2] 谢波[3] 曹芳芳 陈安清[5] 宣建伟 Lin Ziyi;Xiong Weiping;Xie Bo;Cao Fengfeng;Chen Anqing;Xuan Jianwei(Shanghai Centennial Scientific Co., Ltd., Shanghai, 200032;Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangzhou, 510080;Renji Hospital, Shanghai Jiaotong University Medical College, Shanghai, 200127;Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, 100037;Ruijin Hospital, Shanghai Jiaotong University Medical College, Shanghai, 200025;Health Economic Research Institute, Sun Yat-Sen University, Guangzhou, 510006)

机构地区：[1]上海盛特尼医药科技有限公司,上海200032 [2]广东省人民医院广东省心血管病研究所,广州510080 [3]上海交通大学医学院附属仁济医院,上海200127 [4]中国医学科学院阜外医院,北京100037 [5]上海交通大学医学院附属瑞金医院,上海200025 [6]中山大学医药经济研究所,广州510006

出　　处：《中国医疗保险》2019年第8期57-63,共7页China Health Insurance

摘　　要：目的:本研究从中国医疗保健支付方的角度,评价体外循环心外科手术围手术期使用乌司他丁的经济性,以期为临床决策提供依据。方法:构建短期决策树联合长期马尔可夫链模型,模拟患者在体外循环心外科手术围手术期使用与不使用乌司他丁两种干预方案的手术预后及转归过程,并根据术后5年的模拟结果从支付方角度进行成本效用分析。疗效和效用数据来源于现已发表的临床研究,成本数据来源于北上广临床专家的深度访谈。同时,本研究进行单因素敏感性分析和概率敏感性分析。结果:患者术后5年内,相比不使用乌司他丁,使用乌司他丁能够减少患者的直接医疗成本(7992.17元),并且能够增加患者所获得的QALY(0.0024),行体外循环心外科手术患者在围手术期使用乌司他丁具有绝对经济优势。敏感性分析显示结果具有稳定性,使用乌司他丁具有经济性优势的可能性为72.0%。结论:与不使用乌司他丁相比,围手术期使用乌司他丁具有绝对经济优势。Objectives: This study aimed to evaluate the pharmacoeconomic value of Ulinastatin in perioperative period of cardiac surgery with cardiopulmonary bypass, in order to convey evidence in supporting clinical decision making. Methods: A two-part model (a short-term decision tree and a Markov chain) was constructed to track the prognosis after the cardiac surgery with cardiopulmonary bypass for patients with versus without Ulinastatin. A cost-utility analysis from the payers’ perspective was conducted based on the model. The efficacy and utility data were from published literatures, and the cost variables were acquired from an in-depth interview with clinical experts in three major cities in China. Both one-way sensitivity analysis and probabilistic sensitivity analysis were conducted to assess the uncertainty. Results: In the 5-year time horizon, compared with the operation without Ulinastatin, administrating Ulinastatin reduces the total cost for per patient by CNY 7992.17, while it increases the total QALY gained by 0.0024, indicating that administrating Ulinastatin is cost-saving. The sensitivity analyses confi rmed the robustness of the model result. Conclusion: Administrating Ulinastatin in perioperative period of cardiac surgery with cardiopulmonary bypass is a cost-saving intervention.

关 键 词：体外循环 乌司他丁 成本效用分析 

分 类 号：F840.684[经济管理—保险] C913.7[社会学]