基于他克莫司的免疫抑制方案用于稳定儿童肝移植受者的成本-效用分析  

Cost-utility of tacrolimus-based immunosuppression regimens in stable pediatric liver transplant recipients

作　　者：刘冉佳 李婧[1] 徐烨 徐菀佚 崔向丽 LIU Ranjia;LI Jing;XU Ye;XU Wanyi;CUI Xiangli(Department of Pharmacy,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China;School of Pharmacy,Capital Medical University,Beijing 100069,China)

机构地区：[1]首都医科大学附属北京友谊医院药学部,北京100050 [2]首都医科大学药学院,北京100069

出　　处：《中国医院药学杂志》2023年第24期2804-2808,共5页Chinese Journal of Hospital Pharmacy

基　　金：北京市通州区科技计划项目(编号:KJ2022CX039)。

摘　　要：目的:对儿童肝移植术后以他克莫司为基础的不同免疫抑制方案进行成本-效用分析。方法:基于全社会角度,采用马尔可夫(Markov)模型进行成本-效用分析,模拟中国儿童肝移植受者接受速释他克莫司单药治疗、缓释他克莫司单药治疗、速释他克莫司+霉酚酸联合治疗的健康结果和疾病经济负担,开展成本-效用分析,并进行单因素和概率性敏感性分析。成本参数来自首都医科大学附属北京友谊医院儿童肝移植受者就诊费用,生命质量参数来源于问卷调查,临床疗效通过已发表文献获得。结果:在10年研究时限下,以3倍人均GDP(242 928元)为意愿支付阈值(willingness to pay, WTP),缓释他克莫司单药治疗具有经济学优势,其成本为254 854.25元,质量调整生命年(quality adjusted life years, QALY)为5.50,增量成本效果比(incremental cost-effectiveness ratio, ICER)为61 901.94元/QALY。单因素敏感性分析结果显示,排斥反应发生的概率、健康效用值、成本等各项因素在一定范围内变化时,缓释他克莫司单药治疗的ICER始终小于WTP,具有成本-效用。概率敏感性分析结果显示,当WTP大于58 958元时,缓释他克莫司单药治疗具有成本-效用的概率最大。WTP为3倍GDP时,缓释他克莫司单药治疗具有成本-效用的概率为81.4%。结论:对于稳定儿童肝移植受者,移植后10年内使用缓释他克莫司单药治疗更具成本-效用。OBJECTIVE To conduct a cost-effectiveness analysis of different immunosuppressive regimens based on tacrolimus after liver transplantation in children.METHODS Based on the perspective of the whole society,this study uses the Markov model for cost-utility analysis.Through this model,the health results and disease economic burden of Chinese children liver transplantation recipients receiving immunosuppressive therapy(immediate-release tacrolimus alone,prolonged-release tacrolimus alone,immediate-release tacrolimus+mycophenolic acid)were simulated,and incremental cost-utility ratio was calculated.Deterministic sensitivity analysis and probabilistic sensitivity analysis were carried out.The cost parameter collected from the medical expenses of pediatric liver transplant recipients in Beijing Friendship Hospital,Capital Medical University.Quality of life parameters come from questionnaires.Clinical efficacy was obtained from the published literature.RESULTS Under the 10-year time horizon,taking 3 times per capita GDP(￥242928)as the willingness to pay(WTP)threshold,prolonged-release tacrolimus had cost-utility.The cost was￥254854.25,the quality-adjusted life year(QALY)was 5.50.The incremental cost-effectiveness ratio(ICER)was￥61901.94/QALY.The results of the deterministic sensitivity analysis showed that the incremental cost-utility ratio of PR-Tac is always less than the willing payment threshold when the probability of rejection,the utility value,cost and other factors changed in a certain range.The results of the probabilistic sensitivity analysis showed that prolonged-release tacrolimus was the treatment option with the greatest probability of being the most economically advantageous when the WTP was greater than￥58958.With 3 times GDP as WTP,the probability that PR-Tac has a cost-utility was 81.4%.CONCLUSION For stable pediatric liver transplant recipients,prolonged-release tacrolimus monotherapy within 10 years after transplantation is more cost-effective.

关 键 词：儿童肝移植 免疫抑制 成本-效用 马尔可夫 

分 类 号：R956[医药卫生—药学]