国产盐酸决奈达隆片治疗阵发性/持续性房颤的成本-效果分析

Cost-effectiveness analysis of dronedarone in the treatment of paroxysmal/persistent atrial fibrillation

目的评价阵发性/持续性心房颤动(atrial fibrillation,AF)患者两种治疗方案的成本-效果分析,为医保决策及临床使用提供参考依据。方法基于卫生体系角度,利用Treeage Pro 2011软件构建为期20年的Markov模型,进行如下两种治疗方案成本-效果分析:①盐酸决奈达隆片;②盐酸胺碘酮片。效果指标采用质量调整生命年(quality asjusted life years,QALYs),成本数据来源于中国药学会数据,转移概率和效用值来源于文献。结果基础分析结果显示,国产盐酸决奈达隆片较盐酸胺碘酮片成本高(385158.73元对377863.85元),但效果更优(12.41 QALYs对11.84 QALYs),增量成本效益比=12798.24元/QALY,远小于人均GDP。敏感性分析结果表明,对结果影响最大的因素是心衰效用值、缺血性脑卒中效用值、心衰治疗费用;在支付意愿值为3倍人均GDP时,盐酸决奈达隆片具有经济性优势的概率为94.60%,敏感性分析支持基础分析结果。结论国产盐酸决奈达隆片治疗阵发性/持续性AF具有经济性优势。

Objective To evaluate the cost-effectiveness of two treatment regimens for patients with paroxysmal/persistent atrial fibrillation,and to provide a reference for medical insurance decision-making and clinical use.Methods Based on the health system perspective,a 20-year Markov model was constructed using Treeage Pro 2011 software to conduct cost-effectiveness analysis.The effect indicators were quality-adjusted life years.The cost data came from Chinese pharmaceutical,and the transition probability and utility value came from literature.Results The basic analysis results showed that compared with amiodarone,the dronedarone’s cost was higher(385158.73 yuan vs 377863.85 yuan),and the effect was better(12.41 QALYs vs 11.84 QALYs),the incremental cost effectiveness ratio was 12798.24 yuan/QALY,far less than 1 time GDP.The results of sensitivity analysis showed that the factors that had the greater influence on the results were the utility value of heart failure,the utility value of ischemic stroke,and the cost of heart failure.When willing-to-pay was 3 times GDP,the probability that dronedarone would have an economic advantage is 94.60%,the sensitivity analysis supports the basic analysis results.Conclusion Domestic dronedarone hydrochloride tablets have economic advantages in the treatment of paroxysmal/persistent heart disease.