摘要
目的:评价新型多模式抗抑郁药伏硫西汀治疗抑郁症的成本与效用。方法:构建模拟时间为一年的决策树模型和马尔可夫模型,参数包括自杀风险、有效性参数、安全性参数、转换概率、效用参数、成本参数,输出结果包括总成本、质量调整生命年和增量成本效用比(ICER)。应用单因素敏感性分析和概率敏感性分析检验模型的稳健性。结果:与度洛西汀相比,伏硫西汀成本更高,获得的质量调整生命年也更高。从社会角度分析,ICER值为87164元;从支付方角度分析,ICER值为92987元,均高于2018年我国人均GDP。经单因素敏感性分析,价格是影响ICER值最敏感的因素之一,当伏硫西汀价格增加45%时,ICER值仍低于我国三倍人均GDP。经概率敏感性分析,当支付意愿为我国三倍人均GDP时,伏硫西汀具有成本效果的概率为61.9%。结论:与度洛西汀相比,伏硫西汀更具有效性和安全性,在治疗抑郁症方面更具成本效果。
Objective To evaluate the cost and utility of a new multi-modal antidepressant,fluoxetine,in the treatment of depression.Methods The decision tree model and Markov model with simulation time of one year were constructed.The output included total cost and quality adjusted life year,and incremental cost utility(ICER).Results Compared with duloxetine,fluoxetine was more costly and achieved a higher quality-adjusted life year.From a social perspective,the ICER value was 87164 yuan;from the perspective of the payer,the ICER value was 92987 yuan,which was higher than the per capita GDP of China in 2018.Through single factor sensitivity analysis,price was one of the most sensitive factors affecting ICER value.When the price of fluoxetine increases by 45%,the ICER value was still lower than China's triple GDP per capita.According to the probability sensitivity analysis,when the willingness to pay was three time of the GDP per capita in China,the probability of cost-effectiveness of fluoxetine was 61.9%.Conclusion Fluoxetine was more effective and safer than duloxetine and was more cost effective in treating depression.
作者
刘孟嘉
陈文
LIU Meng-jia;CHEN Wen(School of Public Health,Fudan University,Shanghai 200032,China)
