渴络欣胶囊联用化学药治疗糖尿病肾病的药物经济学评价

Pharmacoeconomic evaluation of Keluoxin capsule combined with chemical medicine in the treatment of diabetic kidney disease

目的 从全社会角度出发,评价渴络欣胶囊联用化学药治疗糖尿病肾病(DKD)的经济性。方法 采用二次文献检索、样本医院病案数据分析、临床专家咨询等方法,构建周期为1年、时限为40年的六状态Markov模型;以质量调整生命年(QALY)为产出指标,贴现率设为5%,并以1倍我国2020年人均国内生产总值(GDP)作为增量成本-效果比(ICER)的判断阈值,评价渴络欣胶囊联用化学药对比单用化学药治疗DKD的经济性。结果 40年间,渴络欣胶囊联用化学药组比单用化学药组人均多花费8 644.09元,多获得0.143 QALYs,ICER为60 460.25元/QALY,小于1倍我国2020年人均GDP(72 447元)。敏感性分析结果显示,渴络欣胶囊年用药天数和早期DKD的健康效用值等变量对经济性分析的结果影响较大。概率敏感性分析结果则提示本研究的基线分析结果稳健。结论 在当前价格水平下,相比单用化学药的治疗方案,渴络欣胶囊联用化学药治疗DKD更具有经济性。在决策应用中需要注意渴络欣胶囊用量和患者健康效用值等变量的取值情况。

OBJECTIVE To evaluate the cost-effectiveness of Keluoxin capsule combined with chemical medicine in the treatment of diabetic kidney disease(DKD)from the perspective of the whole society. METHODS Six-state Markov model with 1year cycle and 40 years time horizon was constructed by means of secondary literature review,medical record analysis of sample hospital and clinical expert consultation. The cost-effectiveness of Keluoxin capsule combined with chemical medicine versus chemical medicine alone for DKD was evaluated by taking the quality-adjusted life year(QALY)as the output index,setting the discount rate as 5%,and taking one time domestic gross domestic product(GDP)per capita in 2020 of China as the judgement threshold of incremental cost-effectiveness ratio(ICER). RESULTS Within 40 years,Keluoxin capsule combined with chemical medicine group spent 8 644.09 yuan per capita more than chemical medicine alone group,and gained more 0.143 QALYs;ICER was 60 460.25 yuan/QALY,which was less than one times GDP per capita of China in 2020(72 447 yuan). The results of sensitivity analysis showed that the annual days of using Keluoxin capsule,the health utility value of DKD at early stage had a great influence on the results of cost-effectiveness analysis. The results of probabilistic sensitivity analysis suggested that the basic analysis results of this study were robust. CONCLUSIONS At the current price level,Keluoxin capsule combined with chemical medicine is more cost-effective to treat DKD than chemical medicine alone. The dosage of Keluoxin capsule and health utility value should be paid attention in specific decisionmaking scenarios.