特利加压素治疗肝硬化门静脉高压食管胃静脉曲张出血的药物经济学评价

Pharmacoeconomic Evaluation of Telisopressin for Injection in the Treatment of Esophageal and Gastric Varices Bleeding with Portal Hypertension in Cirrhosis

目的通过建立Markov模型,对特利加压素、生长抑素及奥曲肽3种治疗肝硬化门静脉高压食管胃静脉曲张出血方案进行成本-效用分析,为临床用药提供循证依据。方法建立Markov模型,模型包括出血、稳定、死亡3个状态。模型的主要结果为总成本、质量调整生命年(quality adjusted life years,QALYs)和增量成本-效用比,参考药品价格、Markov各状态治疗成本、健康效用值、状态转移概率建立模型,采用半周期校正,对3种方案的有效性和经济性进行评价。并对特利加压素价格、奥曲肽价格、再出血率、健康效用值进行单因素敏感性分析探讨参数的不确定性。同时,加入特利加压素死亡率随周期递减的情境分析,再次比较3种药物的经济性。结果在3种用药方案中,特利加压素相对于生长抑素,成本较低,产出较高,具有绝对药物经济学优势;特利加压素相对于奥曲肽,用药方案成本较高,产出也较高,每多获得1QALY的成本处于可接受标准内,具有相对药物经济学优势。敏感性分析结果显示,在特利加压素和生长抑素的方案比较中,再出血率对研究结果影响最大;而在特利加压素和奥曲肽的方案比较中,健康效用对研究结果影响最大。结论特利加压素与生长抑素、奥曲肽相比具有经济学优势。

Objective To provide an evidence-based basis for clinical use of terlipressin, growth inhibitor and octreotide by establishing a Markov model and conducting a cost-utility analysis of 3 regimens for the treatment of portal hypertensive esophagogastric variceal bleeding in liver cirrhosis. Methods A Markov model was developed, and the model included 3 states:bleeding, stable, and death. The main results of the model were total cost, quality adjusted life year(QALY) and incremental cost-utility ratio. The model was constructed with reference to drug prices, Markov treatment costs for each state, health utility values, and state shift probabilities, and half-cycle correction was used to evaluate the effectiveness and economy of the three regimens. The uncertainty of the parameters was also explored by one-way sensitivity analysis of terlipressin price, octreotide price,rebleeding rate, and health utility value. Also, a scenario analysis of decreasing terlipressin mortality with cycle was added to compare the economics of the three drugs again. Results Among the three drug regimens, terlipressin has a lower cost and higher yield than somatostatin, which has an absolute pharmacoeconomic advantage;terlipressin has a higher cost and higher output than octreotide, and the cost of each additional quality-adjusted life year obtained is within acceptable standards, which has a relative pharmacoeconomic advantage. The results of the sensitivity analysis showed that the rebleed rate had the greatest effect on the results of the studies in the protocol comparison of terlipressin and somatostatin, while the health utility had the greatest effect on the results of the studies in the protocol comparisons of terlipressin and octreotide. Conclusion Terlipressin has economic advantages over somatostatin and octreotide.