布地奈德2种吸入给药方案用于轻度哮喘的药物经济学评价  

Pharmacoeconomic evaluation of 2 kinds of inhalation schemes of budesonide for mild asthma

作　　者：饶文晨 宋晓兵 RAO Wenchen;SONG Xiaobing(Dept.of Respiratory,Cangshan Branch,the 900th Hospital of Joint Logistics Support Force of Chinese People’s Liberation Army,Fuzhou 350004,China;Dept.of Quality Management,Ganzhou Fifth People’s Hospital,Jiangxi Ganzhou 341099,China)

机构地区：[1]联勤保障部队第九〇〇医院仓山院区呼吸科,福州350004 [2]赣州市第五人民医院质控科,江西赣州341099

出　　处：《中国药房》2023年第1期78-81,共4页China Pharmacy

基　　金：江西省卫生健康委科技计划项目(No.202212321)。

摘　　要：目的 从我国卫生体系角度出发,评价轻度哮喘患者按需吸入布地奈德/福莫特罗与布地奈德维持治疗联合按需吸入特布他林(以下简称“布地奈德维持治疗”)的经济性。方法 基于一项国际多中心随机对照临床研究(SYGMA 2研究)建立轻度哮喘Markov模型,模拟时限为60年,循环周期为1周。成本仅纳入直接医疗成本,效用值来自SYGMA 2研究中五水平欧洲五维健康量表数据和文献数据。测算轻度哮喘患者上述2种吸入治疗方案的总成本和总产出,贴现率为5%,并采用敏感性分析评价基础研究结果的稳健性。结果 按需吸入布地奈德/福莫特罗方案与布地奈德维持治疗方案的总成本分别为25 884、45 822元,效用值分别为30.51、30.50质量调整生命年,前者为绝对优势方案。单因素敏感性分析结果显示,药品(特布他林、布地奈德/福莫特罗)的价格和平均每天吸入次数是主要影响参数,但对基础分析结果影响不大。概率敏感性分析结果显示,按需吸入布地奈德/福莫特罗方案具有经济性的概率为100%。结论 与布地奈德维持治疗方案相比,轻度哮喘患者使用按需吸入布地奈德/福莫特罗方案更具有经济性。OBJECTIVE To evaluate the cost-utility of as-needed inhaled budesonide/formoterol versus budesonide maintenance therapy combined with as-needed inhaled terbutaline(hereinafter referred to as budesonide maintenance therapy) in patients with mild asthma from the perspective of the Chinese health service system. METHODS A Markov model of mild asthma was established based on an international multicenter randomized controlled clinical study(SYGMA 2 study);the model cycle was one week, and the model had a whole horizon of 60 years. The cost only included direct medical cost, and utility value was derived from the data of EuroQol 5-Dimension 5-Level in the SYGMA 2 study and published literature. The total cost and total output of the above two inhalation therapies for patients with mild asthma were calculated, with discount rate of 5%. The stability of the model was evaluated by sensitivity analysis. RESULTS The total cost of as-needed inhaled budesonide/formoterol and budesonide maintenance therapy were 25 884 yuan and 45 822 yuan, respectively, and the effectiveness were 30.51 qualityadjusted life years(QALYs) and 30.50 QALYs, respectively. The former scheme was an absolute advantage. One-way sensitivity analyses showed that the price of drug(terbutaline and budesonide/formoterol) and average number of inhalations per day were the main influencing parameters, but they had little influence on the results of basic analysis. Probabilistic sensitivity analysis showed that the probability of as-needed budesonide/formoterol being cost-effective was 100%. CONCLUSIONS Compared with budesonide maintenance therapy, as-needed inhalation of budesonide/formoterol in mild asthma patients is more cost-effective.

关 键 词：轻度哮喘 布地奈德 福莫特罗 特布他林 药物经济学评价 按需用药 维持治疗 

分 类 号：R956[医药卫生—药学]