特利加压素注射液治疗食管胃静脉曲张出血成本-效用分析

Cost-Utility of Terlypressin in the Treatment of Esophageal and Gastric Variceal Bleeding

目的对特利加压素与生长抑素治疗食管胃静脉曲张出血进行成本-效用分析,比较2种药物的经济性。方法构建1个出血、不出血、再次出血、死亡4个疾病状态的离散仿真模拟模型,模型的转换概率来源于对文献的Meta分析;用于计算质量生命年各个状态的健康效用值来源文献,成本数据来源医疗机构采集的数据分析。对基础分析的结果采用单因敏感性分析。结果特利加压素与生长抑素相比,治疗食管胃静脉曲张出血每多获得1个质量生命年的成本为65 478.84元;敏感性分析结果显示,每多获得1个质量生命年的成本最高为110 289.46元,低于3倍人均GDP可接受标准。若采用药物说明书中用药时间计算的成本做敏感性分析,则存在成本较低,效果较好的情况。结论同生长抑素相比,特利加压素治疗食管胃静脉曲张出血具有经济性。

OBJECTIVE To evaluate the cost-utility of terlypressin compared with somatostatin in the treatment of esophageal and gastric variceal bleeding（EGVB） in China. METHODS A discrete event simulation model was created with four transition states： bleeding,no bleeding,rebleeding,and death. Transition probability of the model is derived from Meta analysis of the published literature. Used to calculate the quality of life in transition states health utility value source of literature. Cost data was sourced from （ the listing price） of medical institutions. One-way sensitivity analyses were performed. RESULTS In the base case scenario, results showed that terlypressin was more costly and more effective compared with somatostatin, and that incremental cost-utility ratios were 65 478.84 Yuan/QALY. Sensitivity analyses showed that the model was robust, and that all incremental cost-utility ratios were below 110 289.46 Yuan/QALYs ,which is far less than three times gross domestic product （GDP） per capita in China. If using the treatment duration in the instructions to calculate drug costs in the sensitivity analysis, treatment with terlypression has lower cost and better effectiveness. CONCLUSION The model indicates that terlypressin is most likely to be cost-effective versus somatostatin.