抗VEGF类药物与传统激光疗法用于治疗糖尿病性黄斑水肿的药物经济学评价  

Pharmacoeconomic Evaluation of Anti-VEGF Drugs and Laser Photocoagulation for The Treatment of DME in China

作　　者：刘佳[1,2] 蒋亚文[3] 倪惟一 贺小宁 LIU Jia;JIANG Ya-wen;NI Wei-yi;HE Xiao-ning(School of Pharmaceutical Science and Technology,Tianjin University,Tianjin 300072,China;Medicine Policy and Economics Research Center of School of Pharmaceutical Science and Technology of Tianjin University,Tianjin 300072,China;School of Public Health,Sun Yat-sen University,Shenzhen 510006,China)

机构地区：[1]天津大学药物科学与技术学院,天津300072 [2]天津大学药学院医药政策与经济研究中心,天津300072 [3]中山大学公共卫生学院,深圳510006

出　　处：《中国药学杂志》2020年第5期402-407,共6页Chinese Pharmaceutical Journal

摘　　要：目的从中国全社会角度出发,评价抗血管内皮生长因子(vascular endothelial growth factor,VEGF)类药物(雷珠单抗、阿柏西普)与激光光凝用于治疗糖尿病性黄斑水肿的成本-效果。方法构建Markov模型,通过随机对照试验、已发表文献和医院调研获得3种干预措施治疗糖尿病性黄斑水肿的临床疗效、健康效用及成本数据,对各干预措施下患者终身的疾病转归、质量调整生命年(QALYs)及成本进行长期模拟。计算增量成本-效果比(ICER),并进行单因素和概率敏感性分析。结果与激光光凝相比,雷珠单抗的ICER值为61174元·QALY^-1,阿柏西普的ICER值为138232元·QALY^-1,均小于我国3倍人均GDP(59660元,2017年),抗VEGF类药物具有经济性。比较雷珠单抗与阿柏西普,雷珠单抗QALY更高成本更低,占绝对优势。单因素和概率敏感性分析证明了结果的稳健性。结论雷珠单抗、阿柏西普与激光光凝相比,在治疗糖尿病性黄斑水肿方面均具有成本-效果;其中雷珠单抗效果更好成本更低,在治疗糖尿病性黄斑水肿方面占绝对优势。OBJECTIVE To evaluate the cost-effectiveness of ranibizumab and aflibercept compared with laser photocoagulation for the treatment of diabetic macular edema(DME)from Chinese societal perspective.METHODS A Markov model was constructed to simulate the long-term outcomes and costs of treating DME.Transition probabilities were calculated from the raw data of randomized controlled trial and published network Meta-analysis.Health state utilities were estimated through literature,and costs were estimated from experts consultation of 6 hospitals in China and published literature.The primary outcomes of the model were costs,quality-adjusted life years(QALYs),and incremental cost-effectiveness ratio(ICER).Uncertainty was addressed via univariate and probabilistic sensitivity analyses.RESULTS The ICER comparing ranibizumab with laser photocoagulation was￥61174·QALY^-1,comparing aflibercept with laser photocoagulation was￥138232·QALY^-1.Based on the generally accepted ICER threshold of 3 times per-capi-ta GDP(￥59660,2017 China),ranibizumab and aflibercept were found to be cost-effective compared with laser photocoagulation.Comparing ranibizumab with aflibercept,ranibizumab was the dominant therapy,with an incremental gain of 0.03 QALYs and cost savings of￥22053.Univariate and probabilistic sensitivity analysis demonstrated the robustness of the results.CONCLUSION Compared with laser photocoagulation,ranibizumab and aflibercept are the cost-effective treatment for DME;compared with aflibercept,ranibizumab is the dominant treatment for DME.

关 键 词：糖尿病黄斑水肿 雷珠单抗 阿柏西普 激光光凝 药物经济学 

分 类 号：R956[医药卫生—药学]