摘要
目的从中国全社会角度出发,评价抗血管内皮生长因子(vascular endothelial growth factor,VEGF)类药物(雷珠单抗、阿柏西普)与激光光凝用于治疗糖尿病性黄斑水肿的成本-效果。方法构建Markov模型,通过随机对照试验、已发表文献和医院调研获得3种干预措施治疗糖尿病性黄斑水肿的临床疗效、健康效用及成本数据,对各干预措施下患者终身的疾病转归、质量调整生命年(QALYs)及成本进行长期模拟。计算增量成本-效果比(ICER),并进行单因素和概率敏感性分析。结果与激光光凝相比,雷珠单抗的ICER值为61174元·QALY^-1,阿柏西普的ICER值为138232元·QALY^-1,均小于我国3倍人均GDP(59660元,2017年),抗VEGF类药物具有经济性。比较雷珠单抗与阿柏西普,雷珠单抗QALY更高成本更低,占绝对优势。单因素和概率敏感性分析证明了结果的稳健性。结论雷珠单抗、阿柏西普与激光光凝相比,在治疗糖尿病性黄斑水肿方面均具有成本-效果;其中雷珠单抗效果更好成本更低,在治疗糖尿病性黄斑水肿方面占绝对优势。
OBJECTIVE To evaluate the cost-effectiveness of ranibizumab and aflibercept compared with laser photocoagulation for the treatment of diabetic macular edema(DME)from Chinese societal perspective.METHODS A Markov model was constructed to simulate the long-term outcomes and costs of treating DME.Transition probabilities were calculated from the raw data of randomized controlled trial and published network Meta-analysis.Health state utilities were estimated through literature,and costs were estimated from experts consultation of 6 hospitals in China and published literature.The primary outcomes of the model were costs,quality-adjusted life years(QALYs),and incremental cost-effectiveness ratio(ICER).Uncertainty was addressed via univariate and probabilistic sensitivity analyses.RESULTS The ICER comparing ranibizumab with laser photocoagulation was￥61174·QALY^-1,comparing aflibercept with laser photocoagulation was￥138232·QALY^-1.Based on the generally accepted ICER threshold of 3 times per-capi-ta GDP(￥59660,2017 China),ranibizumab and aflibercept were found to be cost-effective compared with laser photocoagulation.Comparing ranibizumab with aflibercept,ranibizumab was the dominant therapy,with an incremental gain of 0.03 QALYs and cost savings of￥22053.Univariate and probabilistic sensitivity analysis demonstrated the robustness of the results.CONCLUSION Compared with laser photocoagulation,ranibizumab and aflibercept are the cost-effective treatment for DME;compared with aflibercept,ranibizumab is the dominant treatment for DME.
作者
刘佳
蒋亚文
倪惟一
贺小宁
LIU Jia;JIANG Ya-wen;NI Wei-yi;HE Xiao-ning(School of Pharmaceutical Science and Technology,Tianjin University,Tianjin 300072,China;Medicine Policy and Economics Research Center of School of Pharmaceutical Science and Technology of Tianjin University,Tianjin 300072,China;School of Public Health,Sun Yat-sen University,Shenzhen 510006,China)
出处
《中国药学杂志》
CAS
CSCD
北大核心
2020年第5期402-407,共6页
Chinese Pharmaceutical Journal
关键词
糖尿病黄斑水肿
雷珠单抗
阿柏西普
激光光凝
药物经济学
diabetic macular edema
ranibizumab
aflibercept
laser photocoagulation
cost-effectiveness
作者简介
刘佳,女,博士研究生,研究方向:药物经济学;通讯作者:贺小宁,女,讲师,研究方向:卫生经济学与药物经济学,Tel:(022)87401830,E-mail:hexn@tju.edu.cn。
