基于决策树模型对我国6种保肝药物治疗药物性肝损伤的成本-效果分析

Cost-effectiveness analysis of the six kinds of hepatoprotective drugs in the treatment of drug-induced liver injury in China based on the decision tree model

目的:对临床常用治疗药物性肝损伤的保肝药物注射剂进行经济学评价。方法:采用决策树分析模型,率值参数、成本参数、效果参数来源于文献资料、北京市医药阳光采购综合管理平台以及专家讨论意见等。观察对象为6种注射剂:异甘草酸镁、多烯磷脂酰胆碱、还原型谷胱甘肽、复方甘草酸苷、硫普罗宁和甘草酸二铵,观察周期为4周。结果:治疗效果异甘草酸镁最高(9.7),甘草酸二铵成本-效果比最低(31.26);显效率异甘草酸镁最高(84.55%),当患者意愿支付值小于3 229.20元、介于3 229.20元~4 122.67元或大于4 122.67元时,最优方案分别为甘草酸二铵、还原型谷胱甘肽、异甘草酸镁。单因素敏感率分析证实这一结果的可靠性。结论:临床医生根据患者的支付意愿来选择最优的治疗方案。医保部门鼓励临床选择异甘草酸镁,并给予选择该药物的患者增加补贴,以提高整体的社会效益。

Objective： To evaluate the pharmacoeconomics of hepatoprotective injections in the treatment of drug-induced liver injury. Methods： Decision tree analysis model was used in the study. Rate parameters, cost parameters and effective parameters were collected from literature, integrated management platform of Beijing medicine sunshine purchase and experts opinions, etc. Drugs evaluated in this study included magnesium isoglycyrrhizinate, polyene phosphatidylcholine, reduced glutathione, compound glycyrrhizin, tiopronin and diammonium glycyrrhizinate. All treatment programs lasted for 4 weeks. Results： Magnesium isoglycyrrhizinate had the highest therapeutic effect（9.7） and diammonium gycyrrhizinate had the lowest cost-effectiveness ratio（31.26）. Magnesium isoglycyrrhizinate showed effective on 84.55% of patients, which was higher than the other five hepatoprotective drugs. When the threshold value of willingness-to-pay（WTP） was less than 3 229.20 RMB, diammonium glycyrrhizinate was the first choice with the highest cost-effectiveness ratio. When the threshold value of WTP ranged from 3 229.20 RMB to 4 122.67 RMB, reduced glutathione was the first choice with the highest cost-effectiveness ratio. When the threshold value of WTP was over 4 122.67 RMB, magnesium isoglycyrrhizinate was the first choice with the highest cost-effectiveness ratio. This conclusion was proved by one-way sensitivity analysis. Conclusion： The optimal treatment with highest cost-effectiveness ratio should be chosen according to patients＇ different WTP values. In order to increase the overall society benefit, we suggested that health care institutions should provide subsidies for patients to encourage the use of magnesium isoglycyrrhizinate.