摘要
目的本研究采用Markov模型对坎地沙坦酯、厄贝沙坦和替米沙坦预防高血压患者卒中和心肌梗死事件进行长期经济学评价,为高血压药物干预提供依据。方法根据高血压疾病自然史构建Markov模型,从全社会角度预测不同治疗方案下患者的医疗费用和获得的质量调整生命年(quality adjusted life years,QALYs),并计算增量成本效果比(incremental cost-effectiveness ratio,ICER)。模型循环周期为1年,研究时限为20年。医疗费用和QALYs均采用5%的贴现率。在此基础上分别进行单因素敏感性、二阶Monte-Carlo模拟和概率敏感性分析。结果基线分析中,坎地沙坦酯由于成本最高而效果最低,处于绝对劣势;厄贝沙坦相较于替米沙坦的增量成本效果比ICER是5 799. 67元/QALY。敏感性分析与基线结果一致。结论与替米沙坦相比,在阈值为49 992元/QALY时,厄贝沙坦具有明显经济学优势;而与这两者相比,坎地沙坦酯均不具有经济性。
OBJECTIVE To investigate the long-term economic consequences of candesartan cilexetil、irbesartan and telmisartan in preventing stroke and myocardial infarction(MI)among hypertension patients using Markov model,to offer the reference for hypertension intervention.METHODS A Markov state transition model was built based on the natural history of hypertension from the societal perspective to estimate the expected health care costs and the quality adjusted life years.Meanwhile,the incremental cost-effectiveness ratio was obtained.One year cycle length and 20 years horizon were adopted.The 5%yearly discount rate was applied to both health care costs and QALYs.One-way sensitivity analysis,second-order Monte-Carlo and probabilistic sensitivity analysis were performed.RESULTS Candesartan cilexetil was at an absolute disadvantage because of the highest cost and the lowest effect in the baseline analysis.The incremental cost-effectiveness ratio for irbesartan versus telmisartan was 5 799.67 yuan/QALY.The sensitivity analysis was consistent with the baseline results.CONCLUSION Irbesartan shows significant economic advantage at the threshold of 49 992 yuan/QALY compared with telmisartan.And candesartan cilexetil is with less economical.
作者
刘利勤
李青
胡明
李美娟
杨涵
LIU Li-qin;LI Qing;HU Ming;LI Mei-juan;YANG Han(School of Pharmacy,Shanxi Medical University Taiyuan 030001,China;Department of Pharmacy,The First Affiliated Hospital of Shanxi Medical University,Taiyuan 030001 China;School of Pharmacy,Sichuan Huaxi University,Chengdu 610000,China)
出处
《中国药学杂志》
CAS
CSCD
北大核心
2019年第2期137-143,共7页
Chinese Pharmaceutical Journal
