结构脂肪乳三腔袋药物对比长链脂肪乳三腔袋药物治疗术后营养不良患者的成本-效果

Cost-effectiveness of Structured Lipid Emulsion Triple-chamber Bag Drug compared with Long-chain Lipid Emulsion Triple-chamber Bag Drug in Postoperative Patients Receiving Parenteral Nutrition

目的使用卫生经济学模型方法,探讨结构脂肪乳三腔袋药物(力卡文■)对比长链脂肪乳三腔袋药物(卡文■)用于中国术后营养不良患者治疗中的经济性,为相关临床决策和医保决策提供药物经济学证据。方法从中国卫生体系角度出发,使用决策树模型分别对术后不适用于肠内营养的营养不良患者使用两种评估药物力卡文■和卡文■进行模拟。模拟时限为当次手术住院期间,结局指标选择为生存率,成本项目为直接医疗费用,相关参数来自已发表文献、专家咨询和力卡文■药物Ⅲ期临床试验。使用单因素和概率敏感性分析、情境分析检验结果的稳健性。结果力卡文■组生存率为97.9%,次均直接医疗费用为48415.3元;卡文?组生存率为96.9%,次均直接医疗费用为50501.9元。力卡文■具有绝对优势。单因素敏感性中,参数变动主要依据文献报告的95%置信区间,其他参数调整±20%,结果显示基础分析结果稳健(即始终具有绝对优势);概率敏感性分析结果显示力卡文■具有经济性的概率为100%,结果均落在第四象限;情境分析使用临床常用补充性肠外营养给药方式,力卡文■同样具有绝对优势。结论长期来看,在现有证据下,结构脂肪乳三腔袋药物效果更好、次均费用更低,相比于当前医保目录内常用长链脂肪乳三腔袋药物具有绝对经济性优势。

Objective Using health economic modeling methods,this study aimed to explore the cost-effectiveness of structured lipid emulsion triple-chamber bag drug(SLE,StructoKabiven■)compared with long-chain lipid emulsion triple-chamber bag drug(LCLE,Kabiven■)in postoperative patients receiving parenteral nutrition in China.The study aimed to provide pharmacoeconomic evidence for relevant clinical and health insurance decisions.Methods From the perspective of the Chinese healthcare system,a decision tree model was used to simulate the use of the two evaluated drugs StructoKabiven■and Kabiven■in malnourished patients who were not suitable for enteral nutrition after surgery.The simulation period was the hospitalization period of the surgery,with the outcome measure the survival rate and the cost items being direct medical costs.The relevant parameters were obtained from published literature,expert consultation,and PhaseⅢclinical trials of the LCTLE drug.The robustness of the results was tested using univariate and probabilistic sensitivity analyses and scenario analysis.Results After simulating 1,000 patient cohorts using the decision tree model,the survival rate in the SLE group was 97.9%,with an average direct medical cost of 48415.3 yuan.In the LCLE group,the survival rate was 96.9%,with an average direct medical cost of 50,501.9 yuan.Therefore,the SLE group had an absolute advantage.Univariate sensitivity analysis showed that the results remained consistent when the parameters were varied within the 95%confidence intervals as documented in the literature.Meanwhile,other parameters underwent adjustments within a range of±20%.Probabilistic sensitivity analysis showed that the probability of cost-effectiveness for the SLE group was 100%,and the results fell within the fourth quadrant.Scenario analysis using the commonly used partial parenteral nutrition administration method in clinical practice also showed an absolute advantage for SLE.Conclusion In the long term,under the existing evidence,SLE is more effective and less costly per patient compared with the commonly used LCLE triple-chamber bag nutrition covered by the current health insurance in China.The results are robust.