摘要
目的:从医疗保健系统的角度,开展泊沙康唑预防中性粒细胞缺乏患者侵袭性真菌病(invasive fungal disease, IFD)的药物经济学评价,为国内IFD的抗真菌药物选择及医保目录遴选、药费控制提供数据。方法:本研究构建决策树模型及后续的Markov模型,采用成本效果分析及增量成本效果分析,对中性粒细胞缺乏患者使用泊沙康唑与氟康唑预防IFD进行药物经济学评价,并对评价结果进行敏感性分析。短期健康结局指标为临床试验中从患者接受抗真菌预防到最后一剂预防结束后7 d内IFD的突破率,长期指标为挽救生命年。结果:基础分析结果显示,泊沙康唑组预防IFD后突破率比氟康唑组低12. 8%,每个患者的总成本节约了412元;终生模型中泊沙康唑组与氟康唑相比每个患者多挽救0.115年的生命。改变药物疗程、氟康嗤价格、贴现率等变量得到的敏感性分析结果与基础分析结果一致。结论:在目前国内环境下,与氟康唑相比,泊沙康唑对中性粒细胞缺乏患者预防IFD的总成本更低且效果更好,是具有成本节约优势的策略。
Objective: To estimate the cost-effectiveness of posaconazole for preventing invasive fungal disease(IFD) among neutropenia patients from the perspective of Chinese healthcare system, and to provide data for the selection of antifungal drugs, the selection of medical insurance catalogue and the control of medication fees for IFD in China. Methods: Decision tree model and subsequent Markov model were constructed. Cost-effectiveness analysis and incremental cost-effectiveness ratio analysis(ICER) were used to evaluate the pharmacoeconomic efficacy of posaconazole and fluconazole in the prevention of IFD in patients with neutrophil deficiency, and the sensitivity analysis of the evaluation results was carried out. Shortterm health outcomes were the breakthrough rate of IFD in clinical trials from patients receiving antifungal prophylaxis to 7 days after the end of the last dose of prophylaxis. Long-term health outcomes were life-year saved(LYS). Results: In the base-case model, posaconazole led to a 12. 8% lower breakthrough rate of IFD and saved $412 per patient compared with fluconazole. In the lifetime model gained 0. 115 LYS per patient relative to fluconazole. The sensitivity analysis results obtained by changing the course of treatment, the price of fluconazole and the discount rate were consistent with the basic analysis results. Conclusion: In China, compared with fluconazole in high-risk patients with neutropenia, posaconazole is a cost-saving prophylactic strategy with lower cost and greater efficacy.
作者
都丽萍
杨辰
李咏恩
张钰宣
梅丹
DU Li-ping;YANG Chen;LI Yong-en;ZHANG Yu-xuan;MEI Dan(Department of Pharmacy,Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China;Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China;School of Pharmacy,the Chinese University of Hong Kong, Hong Kong 999077,China)
出处
《临床药物治疗杂志》
2019年第3期10-14,共5页
Clinical Medication Journal
基金
首都卫生发展科研专项项目(首发2018-3-4017)
