两种剂型卡巴拉汀治疗阿尔茨海默病的成本-效用对比分析

Comparative Cost-utility Analysis of Two Dosage Forms of Rivastigmine in the Treatment of Alzheimer’s Disease

目的:从我国医疗卫生系统角度出发,评价卡巴拉汀胶囊剂对比卡巴拉汀透皮贴剂治疗阿尔兹海默病的经济性。方法:构建马尔可夫模型,模拟患者终身的质量调整生命年和增量成本-效用比,并进行单因素敏感性分析和概率敏感性分析进一步检验模型结果的正确性和稳定性。结果:基础分析结果显示透皮贴剂组患者比胶囊剂组多获得1.10个QALYs的同时,少花费79758.79元,增量成本-效用比为-72507.99元/QALY,为绝对优势方案;单因素敏感性分析显示对模型最敏感的3个因素分别是胶囊剂每周期成本、贴现率及重度状态效用值;概率敏感性分析显示无论意愿支付值多大,透皮贴剂组始终更具成本效用优势。结论:卡巴拉汀透皮贴剂相对于卡巴拉汀胶囊剂成本更低,效用更高,是更具经济性的优势方案。

Objective:To evaluate the economic efficiency of rivastigmine capsule versus rivastigmine transdermal patch in the treatment of Alzheimer’s disease(AD)from the perspective of Chinese medical and health system.Methods:Markov model was constructed to simulate the lifetime quality adjusted life years(QALYs)and incremental cost-utility ratio(ICUR),and one-way sensitivity analysis and probability sensitivity analysis were conducted to further test the correctness and stability of the model results.Results:The results of basic analysis showed that patients in the transdermal patch group gained 1.10 QALYs more than those in the capsule group while spending 79758.79 yuan less,with an ICUR of-72507.99 yuan/QALY,which was the absolute advantage scheme.The one-way sensitivity analysis showed that these three most sensitive factors to the model were the cost per cycle of capsules,the discount rate and the utility value of the severe state.The probability sensitivity analysis showed that transdermal patch group consistently had a cost-effectiveness advantage regardless of the willingness to pay value.Conclusion:Compared with rivastigmine capsule,rivastigmine transdermal patch has lower cost and higher utility,which is a more economical and advantageous scheme.