摘要
目的对寡糖类敷料与非寡糖敷料治疗糖尿病足溃疡(DFU)进行成本效果分析。方法基于DFU的发生、发展路径, 构建经济学评价的成本效果模型Markov模型。假定初始有10 000例DFU患者, 分别进入寡糖类敷料组与非寡糖敷料组, 以评价模型进行20年(40个周期)推算, 将通过文献检索与临床专家咨询获得的两种敷料技术的疗效、成本和效用参数输入模型, 计算两种敷料技术治疗后的长期成本效果, 进行经济学评价[生存队列分析、成本-效果分析、敏感性分析(单因素敏感性分析、亚组分析和概率敏感性分析)]。结果 20年后非寡糖敷料组的生存率为24.59%, 寡糖类敷料组的患者生存率为27.42%。寡糖类敷料组人均总成本更低(非寡糖敷料组为168 069.56元, 寡糖类敷料组为156 881.90元, 后者降低11 187.66元), 健康收益更多(非寡糖敷料组质量调整生命年为4.220年, 寡糖类敷料组为4.471年, 后者提高0.251年), 经济性更优(增量成本效果比为-44 520.838元/质量调整生命年)。敏感性分析结果显示, 愈合状态效用值、寡糖类敷料价格、寡糖类敷料组DFU到愈合状态转移概率、非寡糖敷料价格、小截肢状态效用值等参数对增量成本效果比(ICER)结果影响较大, 截肢状态的误工损失和DFU的健康效用值对研究结果影响较小。结论在目前价格水平下, 与非寡糖敷料对比, 寡糖类敷料治疗DFU具有卫生经济性。
Objective To conduct a cost-utility analysis of the technology lipido-colloid(TLC)with nano-oligo saccharide factor(NOSF)dressing(TLC-NOSF dressing)versus Non-NOSF advanced wound care dressing in the treatment of diabetic foot ulcer(DFU).Methods This study established Markov model based on the development process of DFU disease.An initial cohort of 10000 patients with DFU were assigned to the TLC-NOSF dressing group and the non-NOSF dressing group.Deducted the evaluation model for 20 years(40 cycles),inputted efficacy,cost and health utility parameters,which were obtained by literature review and expert consultation,to evaluate the long-term cost-effectiveness of two dressing groups and implement economic evaluation[survival cohort analysis,cost-effectiveness analysis,sensitivity analysis(univariate sensitivity analysis,subgroup analysis,and probabilistic sensitivity analysis)].Results The results showed that after 20 years of modeling,survival rate of NON-NOSF dressing group was 24.59%,while TLC-NOSF dressing group was 27.42%.TLC-NOSF dressing group has lower cost(NON-NOSF dressing group was 168069.56 yuan,TLC-NOSF dressing group was 156881.90 yuan,The latter saved 11187.66 yuan),higher health utilities[quality-adjusted life year(QALY)of NON-NOSF dressing group was 4.220 years,QALY of TLC-NOSF dressing group was 4.471 years,The latter improved 0.251 years],better cost-effectiveness[incremental cost-effectiveness ratio(ICER)was-44520.838 yuan/QALY].The results of sensitivity analysis showed that utility of healed state,TLC-NOSF dressing price,DFU to health state transition probabilities of the study group,price of Non-NOSF advanced wound care dressing had a great impact on the results of ICER.Conclusions At current price levels,compared with Non-NOSF dressing,TLC-NOSF dressing is more economically efficient in the treatment of DFU.
作者
刘畅
孙爽
陶立波
Liu Chang;Sun Shuang;Tao Libo(Center for Health Policy and Technology Evaluation,Peking University Health Science Center,Beijing 100191,China)
出处
《中华糖尿病杂志》
CAS
CSCD
北大核心
2021年第12期1160-1165,共6页
CHINESE JOURNAL OF DIABETES MELLITUS
关键词
糖尿病足
足溃疡
敷料
卫生经济学
马尔可夫模型
Diabetes foot
Foot ulcer
Dressing
Health economic assessment
Markov model
