基于Markov模型的沙美特罗替卡松治疗哮喘的药物经济学评价  

Pharmacoeconomic evaluation of fluticasone propionate/salmeterol in the treatment of asthma based on the Markov model

作　　者：陆颖 陈林伟 LU Ying;CHEN Linwei(Department of Pharmacy,Taizbou People's Hospital,Jiangsu Taizhou 225300.China)

机构地区：[1]泰州市人民医院药学部,江苏泰州225300

出　　处：《中国医院药学杂志》2025年第6期650-654,共5页Chinese Journal of Hospital Pharmacy

基　　金：国家自然科学基金项目(编号:81903802)。

摘　　要：目的:从中国卫生体系角度出发,评价吸入沙美特罗替卡松(fluticasone propionate/salmeterol,FP/SA)与吸入氟替卡松(fluticasone,FP)治疗哮喘的经济性,为临床用药提供循证治疗依据。方法:基于一项国际多中心随机对照临床研究(AUSTRI研究)建立哮喘Markov模型,模拟FP/SA组和FP组治疗哮喘无急性发作、急性发作及死亡的动态变化,模拟时限为10年,循环周期为1个月。成本仅纳入直接医疗成本,药品单价来源于药智网最新数据,效用值和住院成本来源于文献数据。以2023年3倍国内生产总值(GDP)作为意愿支付(willingness-to-pay,WTP)阈值,应用TreeAge Pro 2011软件进行回乘分析和队列模拟,同时采用敏感性分析评价基础研究结果的稳健性。结果:吸入沙美特罗替卡松与吸入氟替卡松治疗方案的总成本分别为3805.87、3244.64元,效用值分别为11.7056、11.5635 QALYs,FP/SA组相对于FP组的ICER为3949.54元/QALY,小于WTP阈值(268200元/QALY)。单因素敏感性分析结果显示,FP/SA组和FP组药品成本是主要影响参数,但对基础分析结果影响不大。概率敏感性分析结果显示,FP/SA组具有经济性的概率为90.5%。结论:与氟替卡松治疗方案相比,规律吸入沙美特罗替卡松对于哮喘患者来说更具有经济性。OBJECTIVE To evaluate the cost-effectiveness of fluticasone propionate/salmeterol(FP/SA)powder inhalation versus FP powder inhalation in asthma from the perspective of the Chinese health service system,thus providing evidencebased reference for clinical application.METHODS A Markov model of asthma was established based on an international multicenter randomized controlled clinical study(AUSTRI).A Markov state transition model was established for simulating the dynamic changes in three states(event-free,acute exacerbation&death),with the model cycle of one month.The model had a whole horizon of 10 years.The cost only included direct medical cost.The unit price of the drug was derived from the latest data of the YaoZhi website,and the utility value and hospitalization cost were derived from the literature data.Using 3 times of gross domestic product(GDP)in 2023 as the threshold of willingness-to-pay(WTP),TreeAge Pro 2011 software was applied to perform regression analysis and queue simulation,and sensitivity analysis was used to evaluate the robustness of the basic research results.RESULTS The total cost of inhaled FP/SA and FP was 3805.87 yuan and 3244.64 yuan,respectively,and the effectiveness was 11.7056 quality-adjusted life years(QALYs)and 11.5635 QALYs,respectively.The incremental costeffectiveness ratio(ICER)for the FP/SA was 3949.54 yuan/QALY,which was less than the WTP threshold(268200 yuan/QALY).Single factor sensitivity analyses showed that the drug costs in FP/SA group and FP group were the main influencing parameters,but they had little influence on the results of basic analysis.Probabilistic sensitivity analysis showed that the probability of as-needed FP/SA being cost-effective was 90.5%.CONCLUSION Compared with FP maintenance therapy,regular inhalation of FP/SA in asthma patients is more cost-effective.

关 键 词：哮喘 沙美特罗替卡松 氟替卡松 MARKOV模型 药物经济学评价 

分 类 号：R977.1[医药卫生—药品]