丁苯酞序贯疗法对比注射用尤瑞克林治疗中度急性缺血性脑卒中的成本-效用

Cost-Effectiveness of Sequential Therapy with Butylphthalide versus Urinary Kallidinogenase for Injection in the Treatment of Moderate Acute Ischemic Stroke

目的 评价丁苯酞序贯疗法对比注射用尤瑞克林治疗中度急性缺血性脑卒中(AIS)的疗效和经济性。方法 从医疗保障支付方角度出发,纳入2014年1月至2018年12月中度AIS患者的真实世界数据,研究评价的组别包括丁苯酞组和尤瑞克林组,以单次住院期间美国国立卫生研究院脑卒中量表(NIHSS)评分变化作为疗效评价指标,构建决策树模型,使用成本-效用分析对两种治疗药物的经济性进行评价,并采用单因素敏感性分析及概率敏感性分析评价参数变化对模型结果稳定性的影响。结果 基础分析结果显示,丁苯酞组对比尤瑞克林组治疗中度AIS短期可多获得0.0415QALYs,长期可多获得0.044 3QALYs,短期增量成本-效用比(ICUR)为74 111.73元/QALY,长期ICUR为79 222.88元/QALY,均小于中国2020年3倍人均国内生产总值(GDP)。且模型结果有良好的稳健性。结论 当意愿支付阈值为3倍GDP时,从医保角度看,与注射用尤瑞克林相比,丁苯酞序贯疗法治疗中度AIS更具经济学优势。

Objective To evaluate the efficacy and economy of sequential therapy with butylphthalide versus urinary kallidinogenase for injection in the treatment of moderate acute ischemic stroke(AIS).Methods From the perspective of the payer of medical security,the real-world data of moderate AIS patients from January 2014 to December 2018 were included.The study and evaluation groups included butylphthalide group and urinary kallidinogenase group.Taking the score change of the National Institutes of Health Stroke Scale(NIHSS) during a single hospitalization as the efficacy evaluation index,a decision tree model was constructed,and the cost-effectiveness analysis was used to evaluate the economics of the two drugs.Single factor sensitivity analysis and probability sensitivity analysis were used to evaluate the influence of parameter changes on the stability of model results.Results The butylphthalide group could obtain 0.041 5 QALYs more in the short term and 0.044 3 QALYs more in the long term than the urinary kallidinogenase group in the treatment of moderate AIS.The short-term incremental cost-utility ratio(ICUR) was 74 111.73 yuan/QALY and the long-term ICUR was 79 222.88 yuan/QALY,both of which were less than three times the per capita GDP of China in 2020.And the model results had good robustness.Conclusion When the willingness to pay threshold is 3 times of GDP,from the perspective of medical insurance,compared with urinary kallidinogenase for injection,butylphthalide sequential therapy has more economic advantages in the treatment of moderate AIS.