英夫利西单抗、沙利度胺与甲氨蝶呤治疗复发克罗恩病的成本-效用比较分析

Cost-utility of Infliximab,Thalidomide and Methotrexate in the treatment of recurrent Crohn’s disease

目的基于单中心临床治疗成本数据,对英夫利西单抗(Infliximab,IFX)纳入医保前后和沙利度胺(Thalidomide,THA)、甲氨蝶呤(Methotrexate,MTX)在复发克罗恩病(Crohn’s disease,CD)治疗中的成本-效用进行比较分析。方法纳入2009年10月1日至2018年9月30日采用THA、MTX和IFX治疗的复发CD患者,收集其直接医疗成本和CD疾病活动度评分(Crohn’s disease activity index,CDAI)。IFX纳入医保后的相应成本由IFX医保前后费用差价算得。质量调整寿命年(quality adjusted life year,QALY)由CDAI换算得来,QALY原始算法基于EQ-5D量表换算得来。以THA治疗方案为参照进行成本-效用分析,2018年人均GDP为成本-效用评估阈值标准。结果在IFX纳入医保前后,对复发CD患者而言,THA方案人均直接医疗成本最低(0.80万元)。而相对于THA治疗方案,增加单位QALY的不同治疗方案费用:MTX治疗方案花费100万元,IFX纳入医保前需花费133.67万元,但在IFX纳入医保后仅需消耗1.87万元,远低于2018年人均GDP。结论IFX纳入医保后成为复发CD患者极具成本-效用优势的药物治疗方案。

Objective Based on the cost data of treatment from single-center,we compared the cost-utility of Infliximab(IFX),Thalidomide(THA),and Methotrexate(MTX)in the treatment of recurrent Crohn’s disease(CD)before and after the inclusion of IFX in medical insurance.Methods Patients with recurrent CD treated with THA,MTX,and IFX from Oct.1st,2009 to Sep.30th,2018 were enrolled,and their direct medical costs and CD activity index(CDAI)were collected.The cost of IFX after including in the medical insurance was calculated by the price before.The value of quality adjusted life year(QALY)was converted from CDAI and the original QALY algorithm based on the EQ-5D scale.The cost-utility analysis was carried out with the treatment of THA as a reference,and the per capita GDP in 2018 was used as the cost-utility evaluation threshold standard.Results Before and after IFX was included in the medical insurance,the direct medical cost per capita of the THA scheme was the lowest for patients with recurrent CD(8000 yuan).Compared with the treatment of THA,the MTX treatment scheme cost 1 million yuan for increasing per QALY,while IFX cost 1.3367 million yuan before included in the medical insurance,but only 18700 yuan after IFX included in the medical insurance,which was far lower than the per capita GDP in 2018.Conclusion IFX has become a cost-utility drug treatment for patients with recurrent CD after included in medical insurance.