摘要
目的比较血浆置换、半量血浆置换联合双重血浆吸附(DPMAS)、先等量血浆置换再联合DPMAS、先DPMAS再联合等量血浆置换4种人工肝模式治疗肝衰竭的经济学特点。方法用Treeage pro 2011软件构建决策树模型,针对肝衰竭患者早、中、晚期分别计算并比较4种不同治疗模式的成本效果比值及增量成本效果值,且对该模型进行敏感性分析;数据来自课题组前期研究结果。结果肝衰竭早期患者的人工肝治疗,半量血浆置换联合DPAMS方案成本效果比值为89547.79,增量成本效果值为34665.34,低于人均国内生产总值,增加的成本具有成本效果优势;肝衰竭中、晚期,先DPMAS再联合等量血浆置换的方案,成本效果比值分别为122865.5、284334.97,增量成本效果比值分别为70744.55、75299.48,小于3倍人均国内生产总值,增加的成本可以接受,有经济学优势。敏感性分析结果显示基础分析结果可靠。结论对于早期肝衰竭,半量血浆置换联合DPAMS方案最具成本效果优势;而对于肝衰竭中、晚期,采用先DPMAS再联合等量血浆置换是最为经济的人工肝治疗方案。
Objective To compare the economic characteristics of the four artificial liver models[plasma exchange,half-dose plasma exchange combined with double plasma adsorption(DPMAS),pre-equal amount of plasma exchange followed by DPMAS,and pre-DPMAS followed by equal amount of plasma exchange]in the treatment of liver failure.Methods A decision tree model was established with the Treeage pro 2011 software.The cost-effectiveness ratio and incremental cost-effectiveness value of four different treatment modalities were calculated and compared in patients with liver failure at early,mid and late stages,respectively.The sensitivity analysis of the model was performed using data from the preliminary research results of these groups.Results The cost-effectiveness ratio and incremental cost-effectiveness value of patients treated with artificial liver therapy with half-dose plasma exchange combined with DPAMS plan in early stage liver failure were 89547.79 and 34665.34,which was lower than per capita GDP,so the increased cost had cost-effective advantages.In the middle and late stage of liver failure,the cost-effectiveness ratio and incremental cost-effectiveness value of pre-DPMAS followed by equal plasma exchange plan was 122865.5 and 284334.97,and 70744.55 and 75299.48,respectively,which was less than three times of per capita GDP.The increased cost was acceptable and had economic advantages.The sensitivity analysis results showed that the basic analysis results were reliable.Conclusion Half-dose plasma exchange combined with DPAMS plan is the most cost-effective treatment for early liver failure,while pre-DPMAS followed by equal plasma exchange plan is the most economical treatment for mid and late stage liver failure.
作者
孔令希
邱峰
王红梅
单雪峰
胡鹏
钟珊
王娜
Kong Lingxi;Qiu Feng;Wang Hongmei;Shan Xuefeng;Hu Peng;Zhong Shan;Wang Na(Department of Pharmacy,First Affiliated Hospital of Chongqing Medical University,Chongqing 400042,China;Department of Infection,Second Affiliated Hospital of Chongqing Medical University,Institute of Viral Hepatitis,Chongqing Medical University,Key Laboratory of Molecular Biology of Infectious Diseases,Ministry of Education,Chongqing 400010,China)
出处
《中华肝脏病杂志》
CAS
CSCD
北大核心
2020年第5期434-440,共7页
Chinese Journal of Hepatology
关键词
肝衰竭
肝
人工
血浆置换
经济学
Liver failure
Liver
artificial
Plasma exchange
Economics
