摘要
目的评价两性霉素B脂质体经验性治疗侵袭性真菌感染的经济性,为抗真菌药物的临床用药选择及相关医药决策提供参考。方法采用中国卫生体系视角,基于中国诊疗实践构建决策树模型评估两性霉素B脂质体相比伏立康唑用于一线抗真菌经验性治疗1年内的成本-效果。开展单因素敏感性分析和概率敏感性分析评估结果的稳健性,并针对伏立康唑成本和抗真菌二线用药不确定性开展情境分析。结果基于原研药对比的基础分析结果显示,相比伏立康唑组,两性霉素B脂质体组可以增加0.02个生命年,增加0.01个质量调整生命年(QALYs),同时节约直接医疗成本4686.74元,在经济性上为绝对优势方案。敏感性分析结果和更换二线用药的情境分析结果支持基础分析结果的稳健性。将伏立康唑原研药及仿制药的价格同时纳入成本计算的情境下,两性霉素B脂质体组的增量成本-效果比为820167.29元/QALYs。结论在中国当前的临床诊疗环境下,使用两性霉素B脂质体进行一线抗真菌经验性治疗,相比使用伏立康唑原研药的成本更低,健康产出更高,更具有经济性。
Objective To evaluate the economics of liposomal amphotericin B in empiric treatment of invasive fungal disease(IFD),with the aim of informing clinical usage of antifungal drugs and medical decisions.Methods From the health system perspective,a decision tree model was constructed on the basis of Chinese clinical practices.Cost effectiveness analysis was conducted on liposomal amphotericin B and voriconazole injection in treating IFD empirically as first-line antifungal drugs in 1 year.Sensitivity analyses and scenario analyses on cost of voriconazole injection and second-line drug choice were performed to test the robustness of base-case analysis results.Results The results of base-case analysis showed that liposomal amphotericin B group could save¥4686.74,while gain 0.02 more life years and 0.01 more quality-adjusted life years(QALYs)compared with voriconazole group(brand-name drug),and thus economically dominant.Sensitivity analyses results and scenario analysis with different second-line drug choice were consistent with base-case analysis results.While when generic drug costs of voriconazole were also included in cost calculation,the incremental cost-effectiveness ratio would be¥820167.29/QALYs.Conclusion Based on current Chinese diagnosis and treatment practices,liposomal amphotericin B is economically dominant compared with voriconazole injection brand-name drug as first-line antifungal in empiric treatment.
作者
朱晓晨
王春萍
郑彧
李薇
朱贺
海沙尔江·吾守尔
史录文
韩晟
ZHU Xiao-chen;WANG Chun-ping;ZHENG Yu;LI Wei;ZHU He;WUSHOUER Haisha-erjiang;SHI Lu-wen;HAN Sheng(International Research Center for Medicinal Administration,Peking University,Beijing 100191,China;School of Pharmaceutical Science,Peking University,Beijing 100191,China)
出处
《临床药物治疗杂志》
2023年第11期12-19,共8页
Clinical Medication Journal
基金
国家自然科学基金(82273899)。
