玉屏风颗粒治疗儿童反复呼吸道感染成本-效果分析

A Cost-Effectiveness Analysis of Yupingfeng Granules for the Treatment of Children with Newly Diagnosed Recurrent Respiratory Tract Infections in China

目的运用成本-效果研究方法,评价玉屏风颗粒联合常规治疗对比常规治疗及玉屏风颗粒联合匹多莫德对比单独使用匹多莫德治疗儿童反复呼吸道感染(RRTIs)的经济性。方法建立决策树模型,模拟儿童RRTIs的治疗流程,评估时间为6个月及12个月。通过文献综述获取流行病学、临床疗效数据,通过在全国5个不同城市各选取一家三甲医院进行儿科医师问卷调查及患者病历回顾方法,获取患者就诊流程及治疗费用数据,将获取数据纳入模型进行成本-效果分析。单因素敏感性分析用来评估模型结论的可靠性。结果相对常规治疗,玉屏风颗粒联合常规治疗,12月内可避免4.65次复发,每避免一次复发的经济学增量成本为-1005.85元。在6个月与12个月两个不同的评估评估时间内玉屏风颗粒联合匹多莫德相比匹多莫德单独用药可避免3.58次、7.16次呼吸道感染复发,每避免一次复发的经济学增量成本比为-994.97元、-1023.79元。结论玉屏颗粒联合常规治疗相对常规治疗、玉屏风颗粒联合匹多莫德相对匹多莫德单用治疗小儿RRTIs,具有较好的疗效,能够减少RRTIs发生次数,具有绝对的成本-效果优势,疗效提高,总体医疗花费减少。

Objective To evaluate the cost-effectiveness of Yupingfeng combined with conventional treatment vs. Conventional treatment and Yupingfeng Granules Combined with Pidotimod vs.Pidotimod alone to treat newly diagnosed recurrent respiratory tract infections children in China.Methods A decision tree model was constructed and the treatment impact was projected up to 6 months and 12 months. The epidemiological data and clinical efficacy were obtained from literatures. The cost of medication and disease treatment information was collected through a real world chart review study from five hospitals in five cities of China. Clinical experts from these hospitals were requested to complete a questionnaire to document the treatment progress and medical treatment costs. One-way sensitivity analysis was performed to evaluate the robustness of the results.Results When compared to conventional treatment alone, Yupingfeng combined with conventional treatment could avoid 4.65 times infections, and archived incremental cost effectiveness ratio（ICER） of $-1005.85 for per recurrent tract infections avoided in 12-month time horizon; For the 6-month and 12-month time horizons, compared to Pidotimod alone treatment group, the Yupingfeng Granules combined with pidotimod treatment group could avoiding 3.58 and 7.16 respiratory tract infections. The Yupingfeng Granules Combined with Pidotimod achieved an incremental cost effectiveness ratio（ICER） of $-994.97 and $-1023.79 for per recurrent tract infections avoided in 6-month, 12-month time horizon. These results indicated the combination treatment is a dominant cost effectiveness treatment when compared with the conventional treatment and Pidotimod alone treatment.Conclusion the Yupingfeng Granules combined with conventional treatment and Yupingfeng Granules combined Pidotimod achieved overall better clinical efficacy which result in less recurrent respiratory tract infections. The cost-effectiveness analysis results demonstrated that Yupingfeng Granules Combinedwith conventional treatment and Yupingfeng Granules combined with Pidotimod therapy would be considered a dominant cost-effective therapy compared with conventional treatment, Pidotimod alone therapy with overall better efficacy and lower costs.