沙库巴曲缬沙坦治疗中国射血分数降低心力衰竭患者的药物经济学评价

Economic evaluation of sacubitril/valsartan in the treatment of heart failure with reduced ejection fraction in China

目的评价沙库巴曲缬沙坦对比依那普利治疗中国射血分数降低心力衰竭(HFrEF)患者的经济性。方法基于PARADIGM-HF临床研究结果和相关文献资料,构建循环周期为1个月、时限为20年的多状态Markov模型,从中国医疗卫生角度,模拟沙库巴曲缬沙坦和依那普利治疗中国HFrEF患者的质量调整生命年(QALY)和直接医疗成本,用成本-效用分析方法评估沙库巴曲缬沙坦对比依那普利治疗中国HFrEF患者的经济性,并用敏感性分析验证结果的稳健性。结果与依那普利相比,沙库巴曲缬沙坦治疗HFrEF患者的QALY增加0.53个,直接医疗总成本增加23368元,增量成本效用比(ICER)为44439元/QALY。单因素敏感性分析提示沙库巴曲缬沙坦与依那普利的全因死亡风险比对ICER值影响最大。概率敏感性分析显示沙库巴曲缬沙坦更具经济性的可能性为94%。结论用沙库巴曲缬沙坦较依那普利治疗中国HFrEF患者更具有长期的药物经济学优势。

Objective To evaluate the economy of sacubitril/valsartan versus enalapril in the treatment of heart failure with reduced ejection fraction(HFrEF)in China.Methods Based on the results of the PARADIGM-HF trial and related literature,a multistate Markov model with a cycle period of one month and a lifetime horizon of 20 years was constructed to simulate the quality adjusted life years(QALYs)and direct medical cost from a Chinese medical and health perspective.A cost-utility assay was assessed to evaluate the economy of sacubitril/valsartan versus enalapril in the treatment of patients with HFrEF.The robustness of the results was verified by sensitivity analysis further.Results Compared with enalapril,the QALYs of sacubitril/valsartan was increased by 0.53 and the total direct cost of sacubitril/valsartan got raised by￥23368.Meanwhile,cost-effectiveness ratio(ICER)was elevated by 44439 per QALY as compared to enalapril.In addition,the single factor sensitivity analysis showed that the risk ratio of all-cause death of sacubatrovalsartan and enalapril had the greatest impact on ICER value.And the probabilistic sensitivity analysis displayed that the possibility of more economical use of salkubatroxartan reached by 94%.Conclusion Sacubitril/valsartan has a long-term pharmacoeconomic advantage over enalapil in the treatment of patients with HFr EF in China.