基于Markov模型的银杏叶口服制剂治疗缺血性脑卒中药物经济学评价

Pharmacoeconomic evaluation of Ginkgo biloba oral preparation in treatment of cerebral ischemic stroke based on Markov model

目的 评价银杏叶口服制剂联合常规治疗缺血性脑卒中的经济性。方法 从卫生体系角度出发,基于1项随机临床对照研究结果,构建长期Markov模型,模拟轻度残疾、中重度残疾、复发及死亡的动态变化。对照组为化学药常规治疗,试验组为银杏叶口服制剂联合化学药常规治疗。运用TreeAge Pro 2019软件构建药物经济学模型并模拟分析。结果 模型模拟13周期后,试验组的成本和产出分别为202 418.71元和5.15质量调整生命年(QALY);对照组的成本和产出分别为195 982.73元和4.81 QALY。相比对照组,试验组的增量-成本效果比(ICER)为18 519.24元(每个QALY),小于支付意愿阈值。敏感性分析结果显示该经济学评价结果稳定。结论 对于缺血性脑卒中的治疗,相比化学药常规治疗,银杏叶口服制剂联合化学药常规治疗为具有药物经济学优势的治疗方案。

Objective To evaluate the economics of Ginkgo biloba oral preparation combined with conventional therapy for patients with cerebral ischemic stroke.Methods From the perspective of the health system,based on the results of a randomized clinical controlled study,a long-term Markov model was constructed to simulate the dynamic changes of mild disability,moderate to severe disability,recurrence,and death.The experimental group was treated with G.biloba oral preparation combined with normal medication,and the control group was treated with normal medication alone.The cost-utility and sensitivity analysis were performed for two regimens by TreeAge Pro 2019.Results After 13 cycles of model simulation,results showed that the cost and output of oral G.biloba preparation combined with conventional therapy were 202 418.71 yuan and 5.15 QALY(quality adjusted life years),and the cost and output of the conventional therapy were 195 982.73 yuan and 4.81 QALY,respectively.Compared with control group,the incremental cost-effectiveness ratio(ICER) of the experimental group was 18 519.24 yuan/QALY,and it was less than the willingness to pay threshold.Sensitivity analysis supported the robustness of the results.Conclusion For the treatment of cerebral ischemic stroke,compared with the conventional therapy alone,Ginkgo biloba oral preparation combined with conventional therapy is a pharmacoeconomic advantageous treatment.