摘要
目的评估包含硼替佐米的方案治疗中国新诊断多发性骨髓瘤患者的经济性。方法从我国卫生体系角度出发,基于SWOG S0777研究构建Markov模型,模拟时限为10年,循环周期参考治疗周期设定,以质量调整生命年(QALYs)为效用指标,效用和成本均按5%的贴现率进行贴现,意愿支付(WTP)阈值设定为3倍2021年我国人均国内生产总值(GDP,242928元/QALY)。采用成本-效用分析比较地塞米松联合硼替佐米与来那度胺(VRD)方案对比地塞米松联合来那度胺(RD)方案的增量成本-效果比(ICER),并对模型的不确定性进行敏感性分析。结果基础分析结果显示,相比于RD方案,VRD方案可多获得0.65 QALYs,但其治疗成本比RD方案多花费135782.77元,ICER值为206623.35元/QALY,低于本研究设定的WTP阈值,VRD方案具有经济性。单因素敏感性分析显示,无进展生存期的健康效用值对结果影响最大,效用值的降低可能会使ICER高于本研究设定的WTP阈值,导致VRD方案不再具有经济学优势。在3倍2021年我国人均GDP的WTP阈值下,VRD方案具有经济性的概率为86.5%;且随着WTP阈值的增加,VRD方案更具经济性的概率还会有所增加。结论在3倍2021年我国人均GDP的WTP阈值下,与RD方案相比,VRD方案在中国治疗新诊断多发性骨髓瘤具有经济性。
OBJECTIVE To evaluate the cost-utility of regimen containing bortezomib in the treatment of newly diagnosed multiple myeloma in China.METHODS From the perspective of China’s health system,Markov model was constructed based on SWOG S0777 clinical trial.The simulation time limit was 10 years,and the cycle was set with reference to the treatment cycle.Taking quality adjusted life years(QALYs)as the utility index,the utility and cost were discounted at a discount rate of 5%;the willingness to pay(WTP)threshold was set to be 3 times of China’s per capita gross domestic product(GDP)in 2021(242928 yuan/QALY).The incremental cost-utility ratio(ICER)of dexamethasone combined with bortezomib and lenalidomide(VRD)versus dexamethasone combined with lenalidomide(RD)were compared with cost-utility analysis.The sensitivity analysis was performed for the uncertainty of the model.RESULTS Results of baseline analysis showed that VRD regimen could obtain 0.65 more QALYs than RD scheme,but its treatment cost was 135782.77 yuan more than RD regimen,ICER was 206623.35 yuan/QALY,which was lower than the WTP threshold set in this study,VRD regimen was cost-effective.Single factor sensitivity analysis showed that the health utility value in progressive free survival had the greatest impact on the results,the decrease of utility value would make the ICER higher than the WTP threshold,and VRD regimen would no longer have advantages.Under the WTP threshold of 3 times of China’s per capita GDP in 2021,the probability of VRD regimen being cost-effective was 86.5%;with the increase of WTP threshold,the possibility of VRD regimen becoming more cost-effective than RD regimen would increase.CONCLUSIONS Under the WTP threshold of 3 times of China’s per capita GDP in 2021,compared with RD regimen,VRD regimen is cost-effective in the treatment of newly diagnosed multiple myeloma in China.
作者
黄丹
朱元元
肖悦
刘秋莎
刘沙
刘娟
沈正泽
HUANG Dan;ZHU Yuanyuan;XIAO Yue;LIU Qiusha;LIU Sha;LIU Juan;SHEN Zhengze(Dept.of Pharmacy,Yongchuan Hospital of Chongqing Medical University,Chongqing 402160,China;School of Pharmacy,Chongqing Medical University,Chongqing 400016,China;Dept.of Hematology,Yongchuan Hospital of Chongqing Medical University,Chongqing 402160,China)
出处
《中国药房》
CAS
北大核心
2022年第16期2001-2005,2011,共6页
China Pharmacy
基金
重庆市卫生健康委医学科研项目(No.2022WSJK081)
重庆市科卫联合医学科研项目(No.2022MSXM047)
重庆医科大学未来医学青年创新团队发展支持计划项目(No.W0067)。
作者简介
第一作者:黄丹,主管药师,硕士。研究方向:临床药学、药物经济学。E-mail:397409177@qq.com;通信作者:沈正泽,副主任药师,讲师,硕士。研究方向:临床药学。E-mail:317229355@qq.com。
