盐酸乙酰左卡尼汀对比依帕司他治疗糖尿病周围神经病变的成本效果分析

Pharmacoeconomics evaluation of acetyl levocarnitine hydrochloride versus epalrestat in the treatment of diabetic peripheral neuropathy

目的:对盐酸乙酰左卡尼汀对比依帕司他治疗糖尿病周围神经病变(diabetic peripheral neurop-athy,DPN)进行成本效果分析,为相关卫生决策提供科学依据.方法:基于DPN疾病发生发展过程建立马尔可夫模型,采用二次文献研究和专家咨询获得转换概率、成本、效用等相关参数,对盐酸乙酰左卡尼汀与依帕司他治疗DPN的长期成本和健康产出进行经济学评价.结果:成本效果分析结果显示,治疗10年后,研究组的花费比对照组节省2089.69元,多获得0.014个质量调整生命年(QALYs),增量成本效果比值(ICER)为-214090.20元·QALY^(-1).敏感性分析结果提示,评价结果稳健,并且显示对照组轻度DPN到中重度DPN的转移概率和轻度DPN的健康效用值等变量对ICER结果影响较大.结论:在目前价格水平下,盐酸乙酰左卡尼汀对比依帕司他治疗DPN具有卫生经济性.

Objective:To conduct a cost-utility analysis on acetyl levocarnitine hydrochloride versus epalrestat in the treatment of diabetic peripheral neuropathy(DPN)in order to provide scientific basis for medical decisions.Methods:Markov model was established based on development process of DPN disease.After that,the economic evaluation of acetyl levocarnitine hydrochloride and epalrestat on the long-term cost and healthy outcome in the treatment of DPN was done using literature review and expert consultation to obtain the data regarding transition probability,cost,and efficacy,etc.Results:The results of cost-efficacy analysis show that after 10 years of treatment,compared with the control group,acetyl levocarnitine hydrochloride group saved 2089.69 yuan,and obtained additional 0.014 quality-adjusted life years(QALYs),with the incremental cost effectiveness ratio(ICER)value of-214090.20 yuan·QALY^(-1).The results of sensitivity analysis show that the results are robust and the transition probabilities of mild to severe DPN in control group and the utility of mild DPN state had a great impact on the results of ICER.Conclusion:Compared with epalrestat,acetyl levocarnitine hydrochloride is better regarding healthy economy in the treatment of DPN in current circumstances.