摘要
目的:从中国医疗卫生体系角度出发,评价来特莫韦(注射剂与片剂序贯治疗)联合抢先治疗(pre-emptive antiviral therapy,PET)相比于仅接受PET,用于异基因造血干细胞移植(allogeneic hematopoietic stem cell transplantation,Allo-HSCT)后巨细胞病毒(cytomegalovirus,CMV)血清阳性成人受者(R+)预防CMV感染和CMV病的成本-效果。方法:构建短期决策树模型联合长期马尔可夫模型,模拟患者临床产出与成本。模型中的临床参数、效用参数来源于来特莫韦临床试验P001(NCT02137772)和已发表文献,成本数据来源于公开数据库及临床专家调研结果,同时开展单因素敏感性分析和概率敏感性分析。结果:与仅接受PET、不接受CMV预防相比,采用来特莫韦CMV预防联合PET的增量质量调整生命年(quality-adjusted life years,QALYs)为0.44,增量成本-效果比(incremental cost-effectiveness ratio,ICER)为59871元·QALY^(-1),远低于2022年3倍中国人均GDP,经济性良好。概率敏感性分析结果显示,基础分析结果稳健。结论:与仅接受PET、不接受CMV预防相比,来特莫韦用于接受Allo-HSCT后CMV血清阳性成人受者(R^(+))预防CMV感染和CMV病具有成本-效果。
Objective:To conduct a cost-effectiveness analysis of letermovir(sequential injection and tablet therapy)in combination with pre-emptive antiviral therapy(PET),as compared to PET alone,in preventing of cytomegalovirus(CMV)infection and disease in adult CMV-seropositive allogeneic hematopoietic stem cell transplantation(Allo-HSCT)recipients from the perspective of the healthcare system in China.Methods:A short-term decision tree model combined with a long-term Markov model was developed to simulate the clinical outcomes and costs of patients over a lifetime horizon.The clinical and efficacy parameters,incorporated in the model,were derived from the letermovir P001 trial(NCT02137772)and various published literature.Cost data were derived from public databases and through surveys of clinical experts.Both one-way and probabilistic sensitivity analysis were performed.Results:When compared to PET alone,the combination of letermovir prophylaxis with PET resulted in an increment of 0.44 in quality-adjusted life years(QALYs).The incremental cost-effectiveness ratio(ICER)of letermovir prophylaxis combined with PET was 59871 CNY·QALY^(-1),significantly lower than three times of the capita gross domestic product of China,thereby suggesting strong cost-effectiveness.The robustness of these base case analysis results was affirmed by the probabilistic sensitivity analyses.Conclusion:Letermovir,in comparison to PET alone,was deemed to be a cost-effective strategy for preventing CMV infection and disease in adult CMV-seropositive recipients of Allo-HSCT.
作者
吴畏
张潇
Jootun Murvin
贺小宁
WU Wei;ZHANG Xiao;Jootun Murvin;HE Xiao-ning(College of Pharmaceutical Science and Technology,Tianjin University,Tianjin 300072,China;Social Science Survey and Data Center,Tianjin University,Tianjin 300072,China;MSD(UK)Limited,London EC2M 6UR,United Kingdom)
出处
《中国新药杂志》
CAS
CSCD
北大核心
2024年第16期1737-1744,共8页
Chinese Journal of New Drugs
关键词
来特莫韦
异基因造血干细胞移植
巨细胞病毒
成本-效用分析
letermovir
allogeneic hematopoietic stem cell transplantation
cytomegalovirus
cost-utility analysis
