HA树脂血液灌流联合血液透析治疗终末期肾病的成本-效果分析

Cost-effectiveness Analysis of HA Resin Hemoperfusion combined with Hemodialysis in the Treatment of End-stage Renal Disease

目的:比较血液灌流联合血液透析治疗终末期肾病与常规血液净化的经济性,为相关卫生决策提供参考。方法:建立Markov模型,按照是否发生心血管事件,分别模拟终末期肾病患者的疾病进展;治疗方案疗效来源于两项HA树脂血液灌流多中心临床试验研究,成本数据来自真实世界数据,健康状态效用值从文献研究中提取或计算;采用敏感性分析检测模型基础结果的稳定性。结果:相比常规血液净化,采用HA树脂血液灌流联合血液透析治疗的终末期肾病患者在获得更多QALY的同时成本也较高,增量成本-效果比为196992.12元/QALY,但小于中国3倍人均GDP。结论:对采用维持性血液透析治疗的终末期肾病患者,增加HA树脂血液灌流治疗具有一定的经济性。

Objective To compare the economy of hemoperfusion combined with hemodialysis in the treatment of end-stage renal disease with that of conventional blood purification,and to provide reference for relevant health decisions.Methods The Markov model was constructed to simulate the disease progression of patients with end-stage renal disease based on whether cardiovascular events occur.The curative effect of the treatment scheme was obtained from two multicenter clinical trials of HA resin hemoperfusion.The cost data were derived from real world data,and the utility value of health status was extracted or calculated from literature research.Sensitivity analysis was performed to verify the stability of the base case results of the model.Results Compared with conventional blood purification,patients with end-stage renal disease treated with HA resin Hemoperfusion combined with hemodialysis have more QALY and higher costs.The incremental cost-effectiveness ratio was 196992.12 yuan/QALY,but it was less than three times per capita GDP in China.Conclusion For patients with end-stage renal disease treated with maintenance hemodialysis,it is economical to add HA resin Hemoperfusion treatment.