丙戊酸钠用于颅脑手术中预防癫痫的经济性评价

The pharmacogenomics evaluation of sodium valproate used during the perioperative period in prevention of postoperative epilepsy

目的:从医疗机构角度评估脑外伤、脑肿瘤和脑血管疾病患者行开颅术围手术期在常规治疗基础上使用丙戊酸钠预防癫痫的经济性。方法:采用TreeAge构建决策树模型,并代入丙戊酸钠临床试验数据和中国本土的成本数据,评估相比常规治疗,脑外伤、脑肿瘤和脑血管疾病患者行开颅术围手术期使用丙戊酸钠的期望成本。采用单因素敏感性分析和概率敏感性分析验证结果的稳健性。结果:从医疗机构角度出发,相比常规治疗,脑外伤、脑肿瘤和脑血管疾病3类患者在常规治疗基础上使用丙戊酸钠分别使患者期望成本降低12 950. 15元(17 007.94元vs 4057.79元)、28 662.17元(30 400. 27元vs 1778. 10元)、21 523. 90元(26 784.67元vs 5260. 77元)。结果的稳健性较好。结论:基于模型结果,从医疗机构角度出发,如果只考虑丙戊酸钠的药品费用和其由于预防癫痫减少的癫痫相关治疗费用,相比常规治疗,脑外伤、脑肿瘤和脑血管疾病患者行开颅术围手术期在常规治疗基础上使用丙戊酸钠是一种具有经济性的方案。

Objective To evaluate the cost of epilepsy in the perioperative period of craniotomy for patients with brain trauma,brain tumor,and cerebrovascular disease from the perspective of medical institutions,using sodium valproate to prevent epilepsy on the basis of conventional treatment.Methods A decision tree model was established with TreeAge.The clinical trial data of sodium valproate and the cost data in China was used to evaluate the expected cost of sodium valproate in the perioperative period of craniotomy for patients with brain trauma,brain tumor,and cerebrovascular disease,compared with the conventional treatment.Single factor sensitivity analysis and probabilistic sensitivity analysis were used to verify the robustness of the results.Results From the perspective of medical institutions,compared with the conventional treatment,the expect cost of the patients with brain trauma,brain tumor,and cerebrovascular disease treated with sodium valproate reduced by 12 950.15 yuan（17 007.94 yuan vs 4057.79 yuan）,28 662.17 yuan（30 400.27 yuan vs 1778.10 yuan） and 21 523.90 yuan（26 784.67 yuan vs 5260.77 yuan）.The stability of the results was good.Conclusion Based on the results of the model,from the perspective of medical institutions,the use of valproate in the perioperative period of craniotomy on the basis of conventional treatment in patients with brain trauma,brain tumors,and cerebrovascular diseases is an economical scheme,if only considering the cost of sodium valproate and the cost of epilepsy related to the prevention of epilepsy.