小剂量激素联合他克莫司或环磷酰胺治疗成人特发性膜性肾病的成本-效果分析  

Cost-effectiveness analysis of low-dose steriod combined with tacrolimus or cyclophosphamide in the treatment of adult idiopathic membranous nephropathy

作　　者：郭珊珊[1] 郭莉[1] 李建东[1] 郑喜洁 陈航[1] GUO Shanshan;GUO Li;LI Jiandong;ZHENG Xijie;CHEN Hang(Department of Nephrology,Affiliated Hospital of Hebei University,Baoding 071000,Hebei Province,China)

机构地区：[1]河北大学附属医院肾脏内科,河北保定071000

出　　处：《药物流行病学杂志》2025年第2期175-181,共7页Chinese Journal of Pharmacoepidemiology

基　　金：保定市科技计划项目(2041ZF316)。

摘　　要：目的评价小剂量激素联合他克莫司治疗成人特发性膜性肾病(IMN)的成本-效果。方法采用前瞻性队列研究设计,收集2018年12月—2022年4月在河北大学附属医院就诊的IMN患者的临床资料,根据治疗方案分为暴露组(小剂量激素联合他克莫司)和对照组(小剂量激素联合环磷酰胺),采用倾向性评分匹配法均衡两组基线资料。以总缓解率为效果指标,采用决策树模型进行成本-效果分析,并采用单因素敏感性分析和概率敏感性分析验证结果的稳健性。结果共纳入112例IMN患者,进行倾向性评分匹配后,暴露组和对照组均纳入46例患者。暴露组总缓解率84.78%,成本为13352.64元,成本-效果比为157.50;对照组总缓解率80.43%,成本为8154.18元,成本-效果比为101.38,两组增量成本-效果比为1195.05,敏感性分析结果与成本-效果分析结果基本一致。结论两种治疗方案治疗IMN各具优势,小剂量激素联合他克莫司成本-效果比相对较高,小剂量激素联合环磷酰胺素更具有经济性,两种方案均具有一定的临床推广价值。Objective To evaluate the cost-effectiveness of low-dose steroid combined with tacrolimus or cyclophosphamide in treating adult idiopathic membranous nephropathy(IMN).Methods A prospective cohort design was used to collect clinical data on IMN patients admitted to the Affiliated Hospital of Hebei University from December 2018 to April 2022.The patients were divided into the exposure group(low-dose steroid combined with tacrolimus)and control group(low-dose steroid combined with cyclophosphamide)according to the treatment regimen.Propensity score matching was employed to balance the baseline characteristics between the two groups.The total response rate was taken as the effect index,cost-effectiveness analysis was conducted by using the decision tree model,and single factor sensitivity analysis and probabilistic sensitivity analysis were used to verify the robustness of the cost-effectiveness analysis results.Results A total of 112 patients with IMN were included.After propensity score matching,46 patients were included in the exposed and control groups,respectively.The total remission rate of the exposure group was 84.78%,with the cost of 13,352.64 yuan and the cost-effectiveness ratio of 157.50.In the control group,the total remission rate was 80.43%,the cost was 8,154.18 yuan,and the cost-effectiveness ratio was 101.38.The incremental costeffectiveness ratio of the two groups was 1195.05,and the sensitivity analysis results were consistent with those of the cost-effectiveness analysis.Conclusion The two treatment schemes have their own advantages in the treatment of IMN.The cost-effectiveness ratio of low-dose hormone combined with tacrolimus is relatively higher,and the combination of low-dose hormone with cyclophosphamide is more economical.Both schemes have certain clinical promotion value..

关 键 词：激素 他克莫司 特发性膜性肾病 决策树模型 药物经济学 

分 类 号：F407.7[经济管理—产业经济]