基于马尔可夫模型的阿达木单抗治疗类风湿关节炎药物经济学评价  

Pharmacoeconomic Evaluation of Adamumab in the Treatment of Rheumatoid Rthritis Based on the Markov Model

作　　者：许男徽 伍嘉韵 韦妮君 周本杰 XU Nanhui;WU Jiayun;WEI Nijun;ZHOU Benjie(The Seventh Affiliated Hospital of Sun Yat-Sen University,Shenzhen,Guangdong,China 518107)

机构地区：[1]中山大学附属第七医院,广东深圳518107

出　　处：《中国药业》2023年第23期137-142,共6页China Pharmaceuticals

基　　金：广东省医院协会药学科研专项基金[2021YSQN05]。

摘　　要：目的评价阿达木单抗联合甲氨蝶呤治疗类风湿关节炎的经济性,为临床合理用药提供参考。方法从医疗卫生体系角度出发,基于2010年美国风湿病学会/欧洲抗风湿病联盟(ACR/EULAR)发布的分类标准,构建模拟疾病缓解、低疾病活动度、中等疾病活动度、高疾病活动度及死亡状态的动态变化马尔可夫(Markov)模型,贴现率为5%,设定意愿支付(WTP)阈值为1~3倍2021年人均国内生产总值(GDP)80976.00~242928.00元,对模型参数不确定性进行单因素敏感性分析和概率敏感性分析。对照组给予甲氨蝶呤治疗,试验组给予阿达木单抗联合甲氨蝶呤治疗。结果循环周期设定为6个月,模型模拟90个循环周期后,对照组的累计成本和累计效用分别为26473.84元和17.40质量调整生命年(QALYs)。试验组降价后的累计成本和累计效用分别为420944.71元和24.63 QALYs;与对照组比较,试验组降价后的增量成本-效用比(ICUR)为每个QALYs 54560.29元,低于1倍2021年GDP。敏感性分析结果显示,经济学评价结果稳定,且随WTP阈值在1~3倍2021年GDP变动时,经济性的概率逐渐增加。结论相比甲氨蝶呤,降价后的阿达木单抗联合甲氨蝶呤治疗类风湿关节炎为我国目前具有药物经济学优势的方案。Objective To evaluate the economy of adalimumab combined with methotrexate in the treatment of rheumatoid arthritis,and to provide a reference for rational clinical medication.Methods From the perspective of the health system,based on the American College of Rheumatology/European League Against Rheumatism(ACR/EULAR)classification criteria in 2010,a Markov model was constructed to simulate the dynamic changes in disease remission,low disease activity,medium disease activity,high disease activity,and death status,with a discount rate of 5%,the willingness to pay(WTP)threshold was set as 1-3 times 2021 China's per capita gross domestic product(GDP)of CNY 80976.00-CNY 242928.00 and the model parameter uncertainty was analyzed by the single factor sensitivity analysis and probability sensitivity analysis.The control group was treated with methotrexate,while the test group was treated with adalimumab combined with methotrexate.Results The cycle period was set to six months,and after simulating 90 cycle periods,the cumulative cost and output in the control group were CNY 26473.84 and 17.40 quality adjusted life years(QALYs),respectively,while those in the test group after price reduction were CNY 420944.71 and 24.63 QALYs,respectively.Compared with those in the control group,the incremental cost utility ratio(ICUR)after price reduction in the test group was CNY 54560.29 per QALYs,which was lower than 1 time the 2021 China's per capita GDP.The sensitivity analysis results showed that the economic evaluation results were stable,and the probability of economic performance gradually increased when the WTP changes at 1-3 times the 2021 China's per capita GDP.Conclusion Compared with methotrexate,adalimumab combined with methotrexate in the treatment of rheumatoid arthritis has pharmacoeconomic advantages in China at the present.

关 键 词：阿达木单抗 类风湿关节炎 马尔可夫模型 药物经济学评价 成本-效用分析 

分 类 号：R956[医药卫生—药学] R975.9