基于马尔科夫模型的雷珠单抗或阿柏西普治疗糖尿病性黄斑水肿的成本-效用对比  

Cost-utiliy comparison of ranibizumab or aflibercept in the treatment of diabetic macular edema based on a Markov model

作　　者：朱艳霞[1] 周如婷 施天严[1] ZHU Yanxia;ZHOU Ruting;SHI Tianyan(Department of Ophthalmology,Lishui Municipal Central Hospital,Lishui 323000,Zhejiang Province,China;Department of Emergency Medicine,Lishui Municipal Central Hospital,Lishui 323000,Zhejiang Province,China)

机构地区：[1]丽水市中心医院眼科中心,浙江丽水323000 [2]丽水市中心医院急诊医学科,浙江丽水323000

出　　处：《中国药师》2024年第7期1155-1161,共7页China Pharmacist

基　　金：浙江省医药卫生科技计划(2018RC018)。

摘　　要：目的对比阿柏西普与雷珠单抗治疗糖尿病性黄斑水肿的成本和效用,以期借助药物经济学的视角,为治疗方案的选择提供参考。方法提取临床用药模式建立马尔科夫模型,模拟在10年内两种治疗方案的生存状态,分别计算成本和健康效用,获得增量成本效用比(ICUR)。与1倍的2022年我国人均国内生产总值(GDP)为意愿支付阈值(WTP)比较,选取成本-效用具有优势的方案。结果在模拟期限内,阿柏西普方案对比雷珠单抗方案,ICUR为61024.22元/质量调整生命年(QALY),低于WTP,具有明显的经济性。单因素敏感性分析显示,使用阿柏西普使视力改善的转移概率、雷珠单抗每年注射次数是ICUR的重要影响因素。概率敏感性分析显示,在WTP为1倍GDP时,阿柏西普具有显著的成本-效用优势,经济概率为63.7%,结果较为稳健。结论对于治疗糖尿病性黄斑水肿,相比于雷珠单抗,阿柏西普更具有成本-效用优势。Objective To compare the cost and utility of aflibercept and ranibizumab in the treatment of diabetic macular edema(DME),in order to provide a reference for the selection of treatment regimens from the perspective of pharmacoeconomics.Methods The Markov model was established by extracting the clinical medication patterns,the survival status of the two treatment regimens within 10 years were simulated,the cost and health utilities were calculated respectively,and the incremental cost-utility ratio(ICUR)was obtained.Compared with the 2022 per capita gross domestic product(GDP)of China,which was 1 time,as the willingness to pay(WTP),the cost-utility advantage scheme was selected.Results During the simulation period,the ICUR of aflibercept compared with ranibizumab was 61024.22 yuan/quality-adjusted life year(QALY),which was lower than that of WTP,which had obvious economic benefits.Univariate sensitivity analysis showed that the metastasis probability of visual acuity improvement with aflibercept and the number of ranibizumab injections per year were important influencing factors for ICUR.Probabilistic sensitivity analysis showed that when WTP was 1 time of the GDP,aflibercept had a significant cost-utility advantage,the economic probability was 63.7%,and the results were relatively stable.Conclusion For the treatment of DME,aflibercept has a cost-utility advantage over ranibizumab.

关 键 词：糖尿病性黄斑水肿 阿柏西普 雷珠单抗 药物经济学 

分 类 号：R956[医药卫生—药学]