基于Markov模型的肺动脉高压靶向治疗药物的成本-效果分析  

Cost-effectiveness of targeted therapy drugs for pulmonary arterial hypertension:a Markov model analysis

作　　者：赵子影 陈同峰[2] 郭蕊[1] 柴茂 李君霞[1] ZHAO Zi-ying;CHEN Tong-feng;GUO Rui;CHAI Mao;LI Jun-xia(Department of Pharmacy,Henan Provincial Chest Hospital,Henan Zhengzhou 450000,China;Department of Structural Heart Disease,Henan Provincial People’s Hospital/Fuwai Central China Cardiovascular Hospital,Henan Zhengzhou 450000,China)

机构地区：[1]河南省胸科医院药学部,河南郑州450000 [2]河南省人民医院/阜外华中心血管病医院结构性心脏病区,河南郑州450000

出　　处：《中国医院药学杂志》2022年第13期1316-1320,共5页Chinese Journal of Hospital Pharmacy

基　　金：河南省医学科技攻关计划联合共建项目(编号:LHGJ20190763)。

摘　　要：目的:评价中国医疗环境下肺动脉高压一线靶向治疗药物的成本-效果。方法:从支付者角度,根据肺动脉高压的自然转归和现有的医疗成本构建Markov模型。结果指标包括人均总成本、总质量调整生命年和增量成本-效果比,应用一元敏感度和概率敏感度分析验证模型稳定性。结果:基线分析结果显示:在整个生命周期的模拟过程中安立生坦、马昔腾坦、波生坦、他达拉非、西地那非和姑息治疗的人均医疗成本分别为363406.14,481387.69,323264.71,167531.23,41700.08和24507.12元,人均可获得5.61,6.14,5.23,5.88,4.64和2.33个质量调整生命年,姑息治疗作为对照组的增量成本-效果比分别为103410.74,120034.97,103079.80,40351.36和7438.14元/质量调整生命年,小于预设的意愿支付阈值,敏感度分析显示结果稳定。结论:在中国肺动脉高压患者使用安立生坦、马昔腾坦、波生坦、他达拉非和西地那非具有成本-效果性。OBJECTIVE To evaluate the cost-effectiveness of targeted therapies for patients with pulmonary arterial hypertension in China’s medical environment.METHODS Form the payer’s perspective,a Markov model was built based on the nature history of pulmonary arterial hypertension and the current medical cost.The result indicators included per capita medical cost,per capita quality adjusted life year gained and incremental cost-effectiveness ratio(ICER).One-way sensitivity analysis and probability sensitivity analysis were performed to assess the stability of the model.RESULTS The baseline analysis showed that in the life-time simulated treatment,the per capita medical costs for ambrisentan,macitentan,bosentan,tadalafil,sildenafil and alleviative treatment were 363406.14,481387.69,323264.71,167531.23,41700.08 and 24507.12 yuan,and they could obtain 5.61,6.14,5.23,5.88,4.64 and 2.33 QALYs,respectively.The corresponding ICERs respectively were 103410.74,120034.97,103079.80,40351.36 and 7438.14 yuan/QALY,when alleviative treatment was used as the control,which were less than the preset willingness to pay threshold.The sensitivity analysis showed that the results were stable.CONCLUSION The results show that ambrisentan,macitentan,bosentan,tadalafil and sildenafil might be cost-effectiveness options in pulmonary arterial hypertension in China.

关 键 词：肺动脉高压 靶向治疗 成本效果 增量成本-效果比 

分 类 号：R956[医药卫生—药学]