基于Markov模型的三种方案治疗胰腺癌的药物经济学分析  

Pharmacoeconomic analysis of three regimens for the treatment of pancreatic cancer based on Markov model

作　　者：古文亮[1] 杨红 孙国祥 李晓红 GU Wen-liang;YANG Hong;SUN Guo-xiang(Department of Pharmacy,the First Hospital of Lanzhou University,Lanzhou 730000,China;不详)

机构地区：[1]兰州大学第一医院药剂科,兰州730000 [2]兰州市第三人民医院老年科,兰州730050

出　　处：《中国处方药》2024年第10期34-38,共5页Journal of China Prescription Drug

摘　　要：目的通过建立Markov模型,对三种治疗胰腺癌的方案进行药物经济学评价,为临床用药提供循证依据。方法参考药品价格、治疗成本、健康效用值、状态转移概率建立马尔可夫(Markov)模型,对兰州大学第一医院2017年6月~2022年5月三种方案的有效性和经济性进行评价,并进行敏感性分析。结果Markov模型模拟回乘分析结果显示60个周期(5年)后,吉西他滨联合白蛋白结合型紫杉醇方案组(AG方案)的成本-效果比为437903.43元/11.80质量调整生命月(QALMs);吉西他滨联合卡培他滨方案组(GX方案)的成本-效果比为162234.52元/6.58 QALMs;吉西他滨联合替吉奥方案组(GS方案)的成本-效果比为429029.92元/15.64 QALMs。与GX方案相比较,AG方案的成本高出275668.91元,效果高出5.22 QALMs,ICER却为负值,处于绝对劣势;GS方案比GX方案效果高出9.06 QALMs,ICER为正值。结论从成本-效果的角度来看,方案AG的成本最高,治疗效果也相对较差,处于绝对劣势;GS方案比GX方案效果高,ICER也为正值,但成本较高,GX方案为优选方案。从药物经济学的角度来看,GS方案和GX方案相对于AG方案具有更高的性价比,患者在接受治疗后能够获得更长的生存期和更好的生活质量,从而提高整体的经济效果。在实际应用中,需要结合患者的具体情况和医生的专业建议来制定最佳治疗方案。Objective To provide evidence-based basis for clinical medication by establishing a Markov model to evaluate the pharmacoeconomics of three treatment regimens for pancreatic cancer.Methods A Markov model was established with reference to drug prices,treatment costs,health utility values,and state transition probabilities to evaluate the effectiveness and economics of the three regimens in the First Hospital of Lanzhou University from June 2017 to May 2022,and conduct sensitivity analysis.Results The results of the Markov model simulation and back-multiplication analysis showed that after 60 cycles(5 years),the cost-effectiveness ratio of gemcitabine combined with albumin-bound paclitaxel(AG)was 437903.43 yuan/11.80 QALMs,the cost-effectiveness ratio of gemcitabine combined with capecitabine(GX)was 162234.52 yuan/6.58 QALMs,and the cost-effectiveness ratio of gemcitabine combined with 1-tegrioxaban(GS)was 429029.92 yuan/15.64 QALMs.Compared with the GX regimen,the cost of the AG regimen was 275668.91 yuan higher,the effect was 5.22 QALMs higher,but the ICER was negative,which was in an absolute disadvantage;the effect of the GS regimen was 9.06 QALMs higher than that of the GX regimen,and the ICER was positive.Conclusion From the perspective of cost-effectiveness,the AG regimen has the highest cost and relatively poor treatment effect,putting it at an absolute disadvantage;the GS regimen is more effective than the GX regimen and has a positive ICER,but the cost is higher,the GX regimen is the preferred regimen.From the perspective of pharmacoeconomics,the GS regimen and the GX regimen are more cost-effective than the AG regimen,patients can achieve longer survival and better quality of life after receiving treatment,thus improving the overall economic benefits.In practical applications,the best treatment regimen needs to be formulated based on the patient's specific situation and the doctor's professional advice.

关 键 词：MARKOV模型 胰腺癌 药物经济学 吉西他滨 白蛋白结合型紫杉醇 卡培他滨 成本-效果 

分 类 号：R735.9[医药卫生—肿瘤]