中国绝经后骨质疏松症妇女不同抗骨质疏松治疗方案的经济学评价  

Economic evaluation of different anti-osteoporosis treatment regimens for postmenopausal women with osteoporosis in China

作　　者：哈娜[1] 张新建[1] 海鑫 HA Na;ZHANG Xin-jian;HAI Xin(Department of Pharmacy,the First Clinical Hospital of Harbin Medical University,Harbin 150001,China)

机构地区：[1]哈尔滨医科大学附属第一医院药学部,黑龙江哈尔滨150001

出　　处：《中国药物应用与监测》2023年第3期147-153,共7页Chinese Journal of Drug Application and Monitoring

基　　金：黑龙江省重点研发计划指导类项目(GZ20210070)。

摘　　要：目的:评价5种不同抗骨质疏松药物治疗中国女性绝经后骨质疏松症(PMOP)的长期成本-效果。方法:从中国医疗卫生体系视角出发,利用Treeage Pro 2019软件构建Markov模型,预测不同治疗方案下患者的累积医疗总成本和所获得的质量调整生命年(QALYs),并计算增量成本-效用比(ICUR)。模型循环周期为1年,研究时限为40年。采用敏感性分析验证结果的稳健性,同时针对不同初始治疗年龄进行情境分析。结果:与碳酸钙/维生素D_(3)基础治疗相比较,地诺单抗和唑来膦酸均为绝对优势方案。阿仑膦酸钠和雷洛昔芬与碳酸钙/维生素D_(3)相比较,ICUR分别为34021.00元·QALY^(-1)和88932.32元·QALY^(-1)。当意愿支付阈值为80976.00元·QALY^(-1)(2021年中国人均GDP的1倍)时,阿仑膦酸钠亦具有显著的药物经济学优势。雷洛昔芬相对于地诺单抗、唑来膦酸和阿仑膦酸钠3种药物,属于绝对劣势方案。特立帕肽与任何其他方案相比较均不具有经济性。结论:对于中国PMOP妇女而言,地诺单抗方案最具成本-效用优势,其次为唑来膦酸治疗方案。Objective:To evaluate the long-term cost-effectiveness of five anti-osteoporosis drugs for women with postmenopausal osteoporosis(PMOP)in China.Methods:Based on Chinese healthcare system,Treeage Pro 2019 software was used to establish Markov model in order to predict the cumulative total medical costs and quality-adjusted life years(QALYs)of patients with different treatment regimens and calculate incremental cost-utility ratio(ICUR).The cycle of the model was 1 year and the research period was 40 years.Sensitivity analysis was used to verify the robustness of the results,and situational analysis was performed for different initial treatment age.Results:Both denosumab and zoledronate showed absolute superiority compared with calcium carbonate/vitamin D_(3)-based therapy.The ICURs of alendronate and raloxifene were 34021.00 yuan·QALY^(-1)and 88932.32 yuan·QALY^(-1)respectively compared with calcium carbonate/vitamin D_(3).When the threshold of willingness to pay was 80976.00 yuan·QALY^(-1)[1 time of China's per capita gross domestic product(GDP)in 2021],alendronate still showed significant pharmacoeconomic advantages.Raloxifene was an absolutely inferior regimen compared with denosumab,zoledronate and alendronate.Teriparatide showed an economical efficiency compared to any other regimen.Conclusion:For Chinese women with PMOP,denosumab had the most cost-effectiveness advantage followed by zoledronate.

关 键 词：绝经后骨质疏松症 成本-效用分析 MARKOV模型 

分 类 号：R956[医药卫生—药学] R977