三联制剂治疗慢性阻塞性肺疾病的药物经济学评价

Pharmacoeconomic evaluation of triple combination therapy for patients with chronic obstructive pulmonary disease

目的对三联制剂倍氯福格(BDP/FF/G)和二联制剂布地奈德福莫特罗(BUD/FF)治疗重度至极重度慢性阻塞性肺疾病进行药物经济学评价。方法基于文献及临床试验建立Markov模型,以卫生体系为研究角度、3个月为循环周期,分别对两种吸入剂药物进行成本-效用分析,并对治疗费用、健康效用值、贴现率等关键变量进行敏感性分析,以检验结果稳定性。结果模拟为期5年的疾病进展后,使用BDP/FF/G的治疗成本为38505.07元,共获得3.09质量调整寿命年(QALYs);使用BUD/FF的成本为45935.46元,共获得3.08QALYs。二者的增量成本-效用比为-743039.00元/QALYs,低于意愿支付阈值(242928元)。结论与布地奈德福莫特罗相比,倍氯福格以较低的成本带来较高的临床效用产出,在慢性阻塞性肺疾病的治疗中更具经济性,属于优势方案。

Objective To conduct the pharmacoeconomic evaluation of beclometasone/formoterol/glycopyrronium and budesonide/formoterol in patients with severe to very severe COPD.Methods From the perspective of health system,Markov model was used to estimale cost-utility analysis of two drugs based on literature and clinical trials with three months every cycle,and sensitivity analysis was made to check the stability of the results,concerning cost,ulitily value and discount ratio.Results After simulating five years of disease progression,patients treated with beclometasone/formoterol/glycopyrronium bromide gained 3.09 Quality-adjusted life years(QALYs)at an expense of￥38505.07,while it was￥45935.46 for 3.08 QALYs with budesonide/formoterol.Therefore,the incremental cost-ulitily ratio was￥-743039.00/QALYs,which was lower than the threshold for willingness to pay(￥242928).Conclusion Compared with budesonide/formoterol,beclometasone/formoterol/glycopyrronium,which brings high clinical efficacy with low cost,can be considered a cost-utility treatment for COPD,which is the dominant strategy.