急性缺血性脑卒中的成本-效果分析——基于中国人群的Markov矩阵分析

Cost-Effectiveness Analysis of Acute Ischemic Stroke:Markov Matrix Analysis Based on Chinese Population

目的:评估丁苯酞氯化钠注射液治疗急性缺血性脑卒中的长期经济学效果,为急性缺血性脑卒中临床用药和治疗决策提供依据。方法:采用多中心、随机、双盲、双模拟、阳性对照试验方法,将220例急性缺血性脑卒中患者随机分为3组,即A1组(丁苯酞氯化钠注射液+丁苯酞软胶囊)、A2组(丁苯酞氯化钠注射液+阿司匹林片)、B组(奥扎格雷钠注射液+阿司匹林片)。根据MRS(即改良的Rankin值)确定的病程的6个健康状态的结果值建立Markov状态转移模型,通过转归模拟寻找疾病达到稳定状态的时间周期,并预测长期成本以及成本-效果比,并在此基础上进行一维敏感度分析。结果:A1组在5个周期(即入组后11个月)最先达到稳定状态,A2组、B组均落后1个周期(即入组后13个月)。A1、A2组达到稳定状态所需成本分别为79396.90、78017.35元,A1组比A2组多1379.54元,B组花费最多为85806.71元。达到稳定状态时,A1、A2、B组的健康状态的成本-效果比分别为8.63、8.21、9.64,可见A1、A2组药物的效果比B组好,并且A2组稍优于A1组。但是考虑达到稳定状态的时间,则A1组比较有经济效果优势,敏感度分析结果也显示A1组经济效果优势稳定。结论:基于Markov模型分析,对于中国急性缺血性脑卒中患者,A1组治疗方案(即丁苯酞氯化钠注射液+丁苯酞软胶囊)是较为经济的选择。

OBJECTIVE：To evaluate the long-term economic effects of Butylphthalide sodium chloride injection for acute ischemic stroke,and to provide clinical basis for the therapy of acute ischemic stroke.METHODS：A multi-center,randomized,double-blind control study was conducted.220 patients with acute ischemic stroke were admitted into three groups,i.e.A1 group,A2 group and B group.A1 group were treated with Butylphthalide sodium chloride injection and butylphthalide sodium chloride capsule,A2 group with Butylphthalide sodium chloride injection and aspirin tablet and B group with Ozagrel injection and aspirin tablet.Markov state transition model was established according to six different health states confirmed by MRS（modified Rankin score）.Based on transferred Markov matrix,the period for disease steady-state was obtained and long-term costs and cost-effectiveness ratio were predicted.One-dimensional sensitivity analysis was performed.RESULTS：A1 group was the first to reach the steady state in five periods（11 months after admission）,A2 group and B group were a period behind （13 months after admission）.The cost of A1 group reaching steady state was 79 396.90 yuan,which was more than A2 group by 1 379.54 yuan.The cost of B group was 85 806.71 yuan.At a steady state,the cost-effectiveness ratio of health state in A1 group was 8.63,A2 group of 8.21 and B group of 9.64.Efficacies of A1 group and A2 group were better than that of B group,and A2 group was slightly better than A1 group.In respect of the time to reach a steady state,the A1 group had advantages of economic effect.In sensitivity analysis,A1 group had stable advantages of economic effect.CONCLUSION：Based on Markov matrix analysis,therapeutic regimen of A1 group is the best choice for the therapy of acute ischemic stroke in China.