沙库巴曲缬沙坦和依那普利在急性失代偿性射血分数减低型心力衰竭住院患者中长期使用的成本-效用  

The Cost Utility of Long-term Use of Sacubitril-valsartan and Enalapril on Hospitalized Patients with Acute Decompensated Heart Failure with Reduced Ejection Fraction

作　　者：姚佑楠 张荣成 安涛 赵信科 张健[1] YAO You-Nan;ZHANG Rong-Cheng;AN Tao;ZHAO Xin-Ke;ZHANG Jian(National Cardiovascular Center,Fuwai Hospital of Peking Union Medical College,Beijing 100037;Affiliated Hospital of Gansu University of Traditional Chinese medicine,Lanzhou 730000,China)

机构地区：[1]国家心血管病中心、北京协和医学院阜外医院,北京100037 [2]甘肃中医药大学附属医院,兰州730000

出　　处：《中国药物经济学》2020年第9期5-11,16,共8页China Journal of Pharmaceutical Economics

基　　金：“十三五”国家科技支撑计划重点项目(2017YFC1308300)。

摘　　要：目的在中国医疗环境下,评价在急性失代偿性射血分数减低型心力衰竭(HFr EF)住院患者中长期使用沙库巴曲缬沙坦和依那普利的成本-效用。方法从支付者角度,应用PIONEER-HF和PARADIGM-HF研究数据,结合目前中国心力衰竭患者的医疗成本、转归及人口学数据构建Markov模型,结果指标包括人均医疗成本、人均质量调整生命年(QALY)和增量成本-效用比(ICER)。使用单因素敏感性分析和概率敏感性分析(PSA)探究模型潜在的不确定性。若ICER小于预设的支付意愿阈值(180042元)时,则沙库巴曲缬沙坦具有较高的成本-效用。结果基础结果显示,在为期20年的模拟治疗中沙库巴曲缬沙坦组(200 mg/次,2次/d)和依那普利组(10 mg/次,2次/d)的人均医疗成本分别为151 210和34 927元,人均可获得6.71和5.73个QALY;对应的ICER为118 995元/QALY,小于预设的支付意愿阈值。单因素敏感性分析显示结果具有稳定性。概率敏感性分析(PSA)结果显示,当支付意愿阈值为180 042元时,60.12%患者使用沙库巴曲缬沙坦具有成本-效用。结论在中国,与依那普利比较,应用沙库巴曲缬沙坦治疗急性失代偿性HFr EF住院患者可能具有一定的经济优势。Objective The cost utility of Sacubitril-valsartan and Enalapril on hospitalized patients with acute decompensated heart failure with reduced ejection fraction was evaluated in China’s medical environment. Methods From the payer’s perspective, PIONEER-HF and PARADIGM-HF research data was used, combined with the current medical cost of patients with heart failure, outcome and the construction of Markov model based on demographic data. The result indicators included per capita medical cost and per capita quality-adjusted life year(QALY) and the incremental cost-utility ratio(ICER). Single factor sensitivity analysis and probability sensitivity analysis(PSA) were used to explore the potential uncertainties of the model. If ICER was less than the preset willingness to pay threshold(180,042 yuan), sacubitril and valsartan had a higher cost utility. Results The basic results showed that in the Sacubitril-valsartan group(200 mg/time, 2 times/d) and the Enalapril group(10 mg/time, 2 times/d) in the 20-year simulated treatment, the per capita medical costs were respectively 151,210 and 34,927 yuan, and each person could get 6.71 and 5.73 QALYs;the corresponding ICER was 118,995 yuan/QALY, which was less than the preset willingness to pay threshold. Single factor sensitivity analysis showed that the results were stable. Probabilistic sensitivity analysis(PSA) results showed that when the willingness to pay threshold was 180,042 yuan, 60.12% of patients used sacubitril and valsartan thad had Cost utility. Conclusion In China, the application of sacubitril and valsartan in the treatment of hospitalized patients with acute decompensated HFrEF may have certain economic advantages.

关 键 词：沙库巴曲缬沙坦 依那普利 成本-效用 射血分数减低型 心力衰竭 中国 

分 类 号：R541.6[医药卫生—心血管疾病] R956[医药卫生—内科学]