动脉粥样硬化性心血管疾病患者附加使用依洛尤单抗的成本效果分析

Cost-effectiveness analysis of the additional use of evolocumab in patients with atherosclerotic cardiovascular disease

目的:对中国的动脉粥样硬化性心血管疾病(ASCVD)患者在常规降脂治疗方案中附加使用依洛尤单抗注射液进行经济学评价。方法:采用马尔科夫(Markov)分析模型,将模拟人群分为附加使用依洛尤单抗组和常规用药组,研究时限为25年。率值参数、成本参数和效果参数源于FOURIER试验及文献资料。效果以质量调整生命年(QALYs)表示。以增量成本-效果比(ICER)评价依洛尤单抗的经济性,进行单因素敏感性分析和概率敏感性分析验证结果可靠性。结果:依洛尤单抗组治疗效果更高为13.27 QALYs,常规用药组的成本更低为368010元。两组相比,依洛尤单抗组的ICER为1182408.18元·QALY^(-1),当降价81.4%时才具有一定的经济学优势(212676元·QALY^(-1))。敏感性分析证实这一结果的可靠性。结论:附加使用依洛尤单抗注射液可得到更好的治疗效果,但对中国ASCVD患者来说可能不具有经济学优势。

Objective:To evaluate the economy of evolocumab in combination with the standard lipid-lowering medication regimen in patients with atherosclerotic cardiovascular disease(ASCVD)in China.Methods:The Markov analysis model was used in the study.Patients were divided into evolocumab group and conventional medication group.The limit of study time was 25 years.The rate parameter,cost parameter and effect parameter were collected from FOURIER experiment and literature.The effectiveness and economics of evolocumab were evaluated by quality adjusted life years(QALYs)and incremental cost-effectiveness ratio(ICER)respectively.Single factor sensitivity analysis and probability sensitivity analysis were used to verify the reliability of the results.Results:The evolocumab group was more effective with the higher QALYs as 13.27 QALYs than the conventional medication group while the cost of the conventional medication group was lower(368010 yuan).The ICER of the evolocumab group was 1182408.18 yuan·QALY^(-1).Only when the price is reduced by 81.4%,it will have a certain economic advantage(212676 yuan·QALY^(-1)).The reliability of the results was verified by sensitivity analysis.Conclusion:Evolocumab in combination with the standard lipidlowering medication regimen in patients with ASCVD in China were more effective without economic advantages.