基于决策树模型对我国中重度抑郁症临床常用药物治疗方案选择的成本效果分析

Cost-Effectiveness Analysis of Clinical Commonly Used Drug Options in the Treatment of Moderate-Severe Depressive Disorder in China:A Decision Tree Model

目的运用药物经济学方法对阿米替林、艾司西酞普兰、米氮平和文拉法辛4种不同机制的临床常用抗抑郁药治疗中国中重度抑郁症患者的成本效果进行分析,对临床合理用药提供参考与建议。方法通过建立决策树模型对4种抗抑郁药物治疗方案进行成本效果分析,并对参数的不确定性进行单因素敏感性分析。结果成本效果分析中,从平均成本效果比来看,阿米替林单位效果所花费的成本为最低为45.24元,米氮平为273.71元,艾司西酞普兰为332.00元,文拉法辛为716.58元。增量成本效果分析中,文拉法辛由于作为绝对劣势方案被排除,每增加1个有效病例的意愿支付金额小于3 420.92元时,最优方案为阿米替林;当意愿支付金额大于3 420.92元且小于4 200元时,最优方案为米氮平;当意愿支付金额大于4 200元时,最优方案为艾司西酞普兰。在敏感性分析中,当米氮平、艾司西酞普兰、文拉法辛成本在给定范围内变动时,只有文拉法辛成本变动对最后结果不产生影响,米氮平、艾司西酞普兰成本的变动会对现有结果产生影响。结论临床医生可以根据患者的支付意愿高低选择最优的治疗方案。医疗保健部门可以鼓励临床使用艾司西酞普兰,并对使用该药的患者提供一定的补贴,以提高总体社会效益。

Objective To evaluate the cost effectiveness of four different mechanisms clinical commonly used antidepressants, namely, amitriptyline, escitalopram, mirtazapine and venlafaxine in the treatment of moderate-severe depressive disorder in China and to provide clinicians with some advice. Methods We carried out the cost- effectiveness analysis of four antidepressants by establishing a decision tree model. The parameters uncertainty in the model was estimated through one-way sensitivity analysis. Results In terms of average cost-effectiveness ratio （CER）, amitriptyline＇s was 45.24 RMB, which was the lowest. And the CERs of mirtazapine, escitalopram and venlafaxine were 273.71 RMB, 332.00 RMB and 716.58 RMB, respectively. While in terms of incremental cost-effectiveness ratio （ICER）, venlafaxine was excluded as the dominated strategy. When the threshold value of willingness to pay （WTP） was less than 3 420.92 RMB, amitriptyline was the most cost-effective; when the threshold value ranges between 3 420.92 RMB and 4 200 RMB, mirtazapine was the most cost-effective; and when the threshold value was over 4 200 RMB, escitalopram was the most cost-effective. In the one-way sensitivity analysis, when we changed the four kinds of drugs costs within a certain range, the results was not changed with the change of venlafaxine＇s cost but changed with the other three drugs costs. Conclusion Clinicians may choose the most cost-effective therapy according to patients＇ different WTP values. We suggests that health care institutions should encourage the use of escitalopram clinically and provide subsidies for patients so as to increase the overall society benefit.