苯环喹溴铵对比布地奈德治疗变应性鼻炎的药物经济学评价

Pharmacoeconomic Evaluation of Phencycloquine Ammonium Bromide vs.Budesonide in the Treatment of Allergic Rhinitis

目的 对比分析苯环喹溴铵治疗变应性鼻炎(AR)的疗效与经济性,为临床提供更加经济、合理的AR用药方案。方法 构建苯环喹溴铵和布地奈德治疗AR的Markov(马尔可夫)模型对患者接受治疗后的生存状态进行模拟,根据AR的疾病特征,模型包括疾病发作和疾病控制两种健康状态。选用决策树模型进行成本-效果分析;采用质量调整生命年(QALYs)作为健康产出指标,以2021年1倍人均GDP作为意愿支付(WTP)阈值判断不同方案的经济性。结果 对比两方案成本和疗效指标数据,苯环喹溴铵治疗方案相较布地奈德治疗方案增量成本-效果比(ICER)值为4 915.87元/QALY,小于既定的1倍人均GDP的WTP阈值,苯环喹溴铵方案与布地奈德方案相比具有成本-效果优势。敏感性分析显示,布地奈德和苯环喹溴铵方案第4周患者的鼻部总症状视觉尺度量表(Multi-VAS)评分是对ICER影响的主要因素,在既定WTP下,苯环喹溴铵对比布地奈德具有经济性的概率为99.98%,苯环喹溴铵作为优势方案结果具有一定稳定性。结论 对于AR,抗胆碱能药苯环喹溴铵对比鼻用糖皮质激素布地奈德更具有成本-效果优势。

Objective To compare and analyze the efficacy and economy of phencycloquine ammonium bromide in the treatment of allergic rhinitis(AR),and provide more economical and reasonable suggestions for the treatment of allergic rhinitis.Methods A Markov model for the treatment of AR with phencycloquine bromide and budesonide was constructed to simulate the survival state of patients after treatment.According to the disease characteristics of AR,the model included two health states:disease onset and disease control.The decision tree model was used for cost-effectiveness analysis;The quality adjusted life years(QALYs)were used as the health output indicators,and the economic efficiency of different schemes was judged by the willing payment threshold of one time of GDP per capita in 2021.Results Comparing the cost and efficacy of the two regimens.The ICER value of phencycloquine bromide regimen was 4915.87 yuan/QALY compared with budesonide regimen,which was less than the established WTP of 1 times of GDP per capita.Compared with budesonide regimen,phencycloquine bromide regimen had cost-effectiveness advantages.Sensitivity analysis showed that Multi-VAS scores of patients in the fourth week of budesonide and phencycloquine bromide regimens were the main factors affecting ICER.Under the established WTP,the probability of economic efficiency of phencycloquine bromide compared with budesonide was 99.98%,and phencycloquine bromide as the dominant regimen had certain stability.Conclusion For allergic rhinitis,the anticholinergic drug phencycloquine and ammonium bromide have more cost-effectiveness advantages than nasal glucocorticoid budesonide.