摘要
目的:评价格卡瑞韦/哌仑他韦(G/P)对比艾尔巴韦/格拉瑞韦(EBR/GZR)治疗基因1b(GT1b)型无肝硬化慢性丙肝初治患者的经济性,为医药卫生决策提供证据支持。方法:在假设G/P和EBR/GZR两种药物治疗方案均采取医保谈判前的中标价格(情境1)和假设EBR/GZR价格下降85%、G/P价格下降80%(情境2)的两种价格情境下构建Markov模型,模拟10000名GT1b型无肝硬化慢性丙肝初治患者队列在不同治疗方案下的终生累计成本和健康产出,计算增量成本-效果比(ICER)。使用单因素敏感性分析和概率敏感性分析对结果进行验证,并在保持情境2其他参数不变的情况下,分析G/P方案具有成本-效果优势的最高价格(降价比例)。结果:在设定的两种情境下,G/P方案相比于EBR/GZR方案成本更高(情境1:68800元vs.62338元;情境2:13760元vs.11490元),健康效用值更高(情境1:14.97 QALY vs.14.90 QALY;情境2:14.97 QALY vs.14.90 QALY),ICER值小于意愿支付阈值(情境1:92314元/QALY;情境2:32428元/QALY);单因素敏感性分析中大部分参数改变不影响基础分析结果,概率敏感性分析证实了基础分析的结果。G/P方案价格至少降低62%才具有成本-效果优势。结论:在设定的价格情境下,G/P方案治疗GT1b型无肝硬化慢性丙肝初治患者较EBR/GZR方案更具有成本-效果优势。
OBJECTIVE:To evaluate the economics of glecaprevir/pibrentasvir(G/P)versus elbasvir/grazoprevir(EBR/GZR)in chronic hepatitis C genotype 1 b(GT1 b)treatment-naive patients without cirrhosis,and to provide evidence support for medical and health decision-making.METHODS:Under assuming the bid price of G/P and EBR/GZR therapy schemes before medical insurance negotiation was adopted(scenario 1)and assuming that the price of EBR/GZR was reduced by 85%and the price of G/P was reduced by 80%(scenario 2),Markov model was developed to simulate the lifetime cost and health outcomes progress of10000 untreated chronic hepatitis C GT1 b treatment-naive patients without cirrhosis and calculate incremental cost-effectiveness ratio(ICER).Single factor sensitivity analysis and probability sensitivity analysis were conducted to verify the results.The highest price(price reduction ratio)of G/P scheme was analyzed with cost-effectiveness advantage,when other parametes kept stable under scenario 2.RESULTS:Under 2 kinds of scenarios,compared with EBR/GZR scheme,G/P scheme had higher cost(scenario1:68800 yuan vs.62338 yuan;scenario 2:13760 yuan vs.11490 yuan)and healty utility(scenario 1:14.97 QALY vs.14.90 QALY;scenario 2:14.97 QALY vs.14.90 QALY),and ICER value of G/P was lower than willingness-to-pay threshold(scenario1:92314 yuan/QALY;scenario 2:32428 yuan/QALY).The change of most parameters in single factor sensitivity analysis didn’t influence the results of base-case analysis,and the findings from the base-case analysis were confirmed by probability sensitivity analyses.The price of G/P scheme needed to be reduced by at least 62%to realize cost-effective advantage.CONCLUSIONS:Under the set price scenario,G/P scheme has cost-effectiveness advantages than EBR/GZR scheme in chronic hepatitis C GT1 b treatment-naive patients without cirrhosis.
作者
陈辰
艾丹丹
路云
CHEN Chen;AI Dandan;LU Yun(School of International Pharmaceutical Business,China Pharmaceutical University,Nanjing 211198,China)
出处
《中国药房》
CAS
北大核心
2020年第9期1113-1118,共6页
China Pharmacy
基金
国家自然科学基金资助项目(No.71673298)。
