摘要
目的:评估TNF-α抑制剂治疗类风湿关节炎的经济性,以期为医疗卫生决策提供循证依据,促进临床合理用药。方法:以"TNF-α"、"类风湿关节炎"、"经济"、"成本-效果"、"成本-效用"、"成果-效益"、"最小成本"为关键词,系统检索中国知网、万方、维普等中文数据库和Cochrane Library、Web of Science、MedLine、PubMed等外文数据库中2015年1月至2019年12月发表的TNF-α抑制剂治疗类风湿关节炎的药物经济学文献,采用QHES量表和Philips清单对纳入文献进行质量评价,并对具体研究结果进行系统综述。结果:最终纳入文献13篇,QHES量表得分为64.77分,Philips清单应答率为59.39%。研究结果显示,相较于csDMRADs,益赛普、阿达木单抗、依那西普成本较高、效果较好,其ICER均处于可接受的范围,并且以赛妥珠单抗为治疗起点的序贯方案是TNF-α抑制剂序贯方案中具有经济性优势的方案。结论:TNF-α抑制剂在类风湿关节炎治疗中具有一定的经济性。此外,建议未来的相关研究在规范研究设计的同时,可通过构建类风湿关节炎序贯治疗方案、运用个体患者模拟模型以进一步探索各治疗药物的长期经济效益。
OBJECTIVE To evaluate the economics of tumor necrosis factor-alpha(TNF-α) inhibitors in the treatment of rheumatoid arthritis(RA), provide rationales for health decision-making and promote clinical rational drug using.METHODS Retrieved from domestic and foreign databases, the economic evaluation literatures on TNF-α inhibitors in the treatment of RA published from January 2015 to December 2019 were collected. The keywords were TNF-α, rheumatoid arthritis, economic evaluation, cost-effectiveness, cost-utility, cost-benefit and cost minimization. And the quality of the literatures was evaluated by the scale of quality of health economics studies and the Philips’ checklist. The specific research results were reviewed systematically.RESULTS A total of 13 literatures were included. The scores of QHES and the response rates of Philips’ checklist on the studies were 64.77 and 59.39% respectively. The results showed that, as compared with csDMRADs, etanercept and adamumab had higher costs and better effectiveness, their ICER was in an acceptable range and the treatment sequence starting with certolizumab was the most economical among the TNF-α inhibitor sequences.CONCLUSION TNF-α inhibitors are economical in the treatment of RA. While standardizing the research methods, relevant researches should construct treatment sequences for RA and use individual patient simulation model to explore the long-term economic benefits of various therapeutic drugs.
作者
徐蔼琳
黄元楷
陈磊
席晓宇
XU Ai-lin;HUANG Yuan-kai;CHEN Lei;XI Xiao-yu(Research Center of National Drug Policy&Ecosystem,China Pharmaceutical University,Jiangsu Nanjing 211198,China)
出处
《中国医院药学杂志》
CAS
北大核心
2021年第7期732-738,共7页
Chinese Journal of Hospital Pharmacy
基金
江苏省高校哲学社会科学研究项目(编号:2019SJA0062)
中国药科大学“双一流”学科创新团队建设项目(编号:CPU2018GY39)。
关键词
肿瘤坏死因子Α
类风湿关节炎
药物经济学
系统综述
tumor necrosis factor-alpha
rheumatoid arthritis
economic evaluation
systematic review
