多维度决策分析在血友病预防性治疗中的应用

Application of Multiple Criteria Decision Analysis in Prophylactic Therapy on Hemophilia A in China

目的:比较影响血友病A治疗的主要疗效因素,评价不同治疗方案的优缺点,进而为治疗方案的决策提供参考。方法:采用多维度决策分析方法 (MDCA),通过组织专家组会议,对反映血友病治疗效果的10个特性因素及其标准剂量的预防治疗、中低剂量预防治疗和按需治疗这三种治疗方案进行评分;并获得不同特性指标的权重。结果:普遍认为标准预防治疗方案最好;对费用分析后发现,标准剂量的预防治疗费用高(34.5万元),但治疗效果远好于中低剂量预防治疗和按需治疗方案。结论:从长期的成本效果分析来看,预防性治疗可以减少并发症的发生,并且降低终生的医疗成本。但目前我国各地对血凝8因子医保报销政策不同,而且补偿水平不一,急需进一步提高。

Objective： To compare the main therapeutic factors of hemophilia A treatment, evaluate the advantages and disadvan- tages of different treatment programs, and then provide a reference for the decision of the treatment program. Methods： Aceording to expert eonferenee, multidimensional decision analysis method（MDCA） approach was applied to score these 10 characteristics of treat- ment effects on hemophilia and the treatment scheme, including standard dose of prevention and treatment, the low dose of preventive treatment and on-demand treatment. Meanwhile, the weights of different chara^teristie indexes were gained. Results： It was generally believed that the standard preventive treatment program was the best. Analysis found that the standard dose of prevention and treat- ment costs was high（345 000 yuan）, while the treatment effect was much better than the low dose of preventive treatment and on-de- mand treatment program. Conclusion： For long-term c, ost-effeetive analysis, standardized prophylaxis treatment could reduce the oc- currence of complication and the lifetime health eare cost. However, the current medical insurance reimbursement policy of FVIII treat- ment on-demand were different and the reimbursement level were ineqnal in China, which needed to be further improved.