4种免疫抑制剂治疗特发性膜性肾病成本-效果分析

Cost-Effectiveness Analysis of Four Immunosuppressive Agents in Treatment of Idiopathic Membranous Nephropathy

目的运用药物经济学评价方法,对环磷酰胺、他克莫司、环孢素、吗替麦考酚酯治疗特发性膜性肾病(IMN)进行成本-效果分析,为临床IMN患者治疗方案的选择提供卫生经济学参考。方法通过查阅文献资料,从网状Meta分析中获得治疗疗程为6个月的缓解率指标,对4种药物治疗IMN建立决策树模型,并进行成本效果分析、单因素敏感性分析和概率敏感性分析。结果通过增量成本效果分析,吗替麦考酚酯为-6826.15元,成为绝对劣势被排除,环孢素相比于环磷酰胺的增量成本效果比为59380元,他克莫司相比于环孢素增量成本效果比为242100元。敏感性分析与成本-效果分析结果基本一致。结论临床医生可以根据患者的支付意愿(WTP)选择最优的治疗方案,他克莫司增量成本效果比相对较高,环磷酰胺和环孢素更具有经济性,推荐临床优先使用。

Objective To evaluate the cost-effectiveness of four immunosuppressive agents,including cyclophosphamide,tacrolimus,cyclosporin,and mycophenolate mofetil,for idiopathic membranous nephropathy,by using pharmacoeconomical method,so as to provide a reference for the cost-effective medication decision.Methods By consulting literatures,the remission rate index of four immunosuppressive agents with a treatment period of six months was obtained from the network meta-analysis,and the cost-effectiveness was evaluated by establishing a decision tree model.Furthermore,one-way sensitivity analysis and probabilistic sensitivity analysis were also conducted.Results Through the incremental cost-effectiveness ratio(ICER)analysis,mycophenolate mofetil was-6826.15 yuan,which became an absolute disadvantage and was then excluded.Compared with cyclophosphamide,the ICER of cyclosporin was 59380 yuan.Compared with cyclosporin,the ICER of tacrolimus was 242100 yuan.The results of sensitivity analysis and cost-effectiveness analysis were in consistency.Conclusion Clinicians may choose the best treatment scheme according to the willingness-to-pay(WTP)of different patients.The ICER of tacrolimus was relatively too high to be accepted,so cyclophosphamide and cyclosporin were more cost-effective.It is recommended to give priority in clinical use.