对比地舒单抗与唑来膦酸治疗实体瘤骨转移的成本-效用  

Cost-utility analysis of Denosumab versus Zoledronic Acid in the treatment of bone metastasis in patients with solid tumor

作　　者：李薇[1,2] 石丰豪 韩晟 LI Wei;SHI Fenghao;HAN Sheng(Department of Academic Research,International Research Center for Medical Administration Peking University,Beijing 100191,China;Department of Pharmacy Administration and Clinical Pharmacy,Peking University School of Pharmaceutical Sciences,Beijing 100191,China)

机构地区：[1]北京大学医药管理国际研究中心学术部,北京100191 [2]北京大学药学院药事管理与临床药学系,北京100191

出　　处：《中国研究型医院》2022年第5期22-28,共7页Chinese Research Hospitals

摘　　要：目的比较皮下注射细胞核因子κB受体活化因子配体(RANKL)抑制剂地舒单抗与静脉滴注唑来膦酸,治疗各类型实体瘤骨转移患者的成本-效用。方法建立全生命周期的马尔科夫模型。干预组为地舒单抗治疗,对照组为唑来膦酸治疗。基于中国卫生体系视角下,分析医疗成本包括药品费用及给药人工费用、医疗资源利用费用、骨相关事件(SREs)治疗费用、不良反应治疗费用。健康产出采用质量调整生命年(QALYs)、增量成本-效用比(ICUR)和减少SREs发生。数据来源为文献研究及临床专家访谈,按照5%的年贴现率进行贴现,采用单因素敏感性分析和概率敏感性分析验证模型的稳健性。结果各癌种加权基础分析结果显示,干预组较对照组可节约成本29700元,增加0.08 QALYs,ICUR为-371250元/QALY,SREs事件数减少0.61。前列腺癌、乳腺癌、非小细胞肺癌以及其他实体瘤骨转移患者亚组分析结果与加权平均结果具有一致性。结论地舒单抗用于治疗实体瘤骨转移患者较唑来膦酸能够节约医疗成本、增加健康产出,是具有绝对优势的治疗方案。Objective To compare the cost-utility of the receptor activator of nuclear factorκB ligand(RANKL)inhibitor,Denosumab,with intravenous Zoledronic Acid for treating patients with bone metastasis from solid tumours.Methods A full life-cycle Markov model was developed.The intervention group was treated with Denosumab,and the control group was treated with Zoledronic Acid.Based on the China healthcare perspective,the analysis of health care costs included drug and administration costs,medical resource utilization costs,patient management,Skeletal Related events(SREs)and adverse events reaction treatment costs.Health outputs used quality-adjusted life-years(QALYs),incremental cost-utility ratios(ICUR)and the reduction of SREs.Data sources were literature studies and interviews with clinical experts,discounted at a 5%annual discount rate,and the robustness of the model was tested using deterministic and probabilistic sensitivity analyses.Results Results of the weighted-basis analysis for each cancer type showed a cost savings of 29700 yuan,an increase of 0.08 QALYs,an ICUR of-371250 yuan per QALY,and a reduction in the number of SREs events of 0.61 in the intervention group compared with the control group.Results of the subgroup analysis for patients with prostate cancer,breast cancer,non-small cell lung cancer and other solid tumour bone metastases were consistent with the weighted average results.Conclusion Compared to Zoledronic Acid,the use of Denosumab for the treatment of patients with bone metastases from solid tumours provides a definite advantage in terms of cost savings and increased health outcomes.

关 键 词：费用效益分析 肿瘤转移 地舒单抗 唑来膦酸 成本-效用分析 

分 类 号：R1[医药卫生—公共卫生与预防医学] R73-37