基于决策树模型的注射用血栓通(冻干)治疗急性缺血性中风气滞血瘀证的成本效果分析

Cost-effectiveness Analysis of Xueshuantong Injection (Lyophilized) in the Treatment of Acute Ischemic Stroke with Qi Stagnation and Blood Stasis Syndrome Based on Decision Tree Model

目的:评价注射用血栓通(冻干)干预急性缺血性中风的经济性,以期为卫生医疗用药资源的合理配置提供经济学参考依据。方法:采用Treeage Pro软件构建了注射用血栓通(冻干)+常规治疗vs常规治疗干预急性缺血性中风气滞血瘀证的决策树模型,成本参数来源于米内网数据库和最新发表的相关文献,同时根据一项公开发表的随机对照研究得出效果参数(临床有效率)评价2种治疗方案短期内的经济性,模型模拟的时间跨度为14天。通过单因素敏感性分析(旋风图)、概率敏感性分析(增量成本效果散点图、成本-效果可接受曲线),对本研究结果的稳健性进行验证。结果:基础分析结果显示,两组的ICER值为6589.15元,约为0.20倍2020年人均可支配收入。即相比于对照组,注射用血栓通(冻干)组每多治疗1例有效的急性缺血性中风气滞血瘀证患者需多花费6589.15元,当患者的意愿支付价格高于6589.15元时,试验组更具有经济性的概率优于对照组。敏感性分析结果验证了基础分析结果的稳健性。结论:假定人均可支配收入(2020年)作为患者的个人意愿支付价格,急性缺血性中风气滞血瘀证患者使用注射用血栓通(冻干)联合常规治疗比单用常规治疗具有经济性的概率更高。

Objective:To evaluate the economy of Xueshuantong Injection(lyophilized) in the intervention of patients with acute ischemic stroke,in order to provide economic references for rational allocation of health and medical drug resources in clinic.Methods:In this study,Treeage Pro software was used to build a decision tree model of Xueshuantong Injection(lyophilized) + conventional treatment vs conventional treatment for the intervention of acute ischemic stroke with Qi stagnation and blood stasis syndrome.The cost parameters were derived from the Menet database and the latest published relevant literature.The short-term economics of the two treatment regimens were evaluated based on an effect parameter(clinical response rate) from a published randomized controlled study.The time span of the model simulation was 14 days.The robustness of this study results was verified by single factor sensitivity analysis(cyclone diagram) and probability sensitivity analysis(incremental cost effect scatter plot and cost-effect acceptability curve).Results:The results of basic analysis showed that the ICER of the two groups was 6589.15 yuan,about 0.20 times the per capita disposable income in 2020.Namely,compared with the control group,Xueshuantong Injection(lyophilized) group needed 6589.15yuan more for each case of additional ef fective acute ischemic stroke patient with Qi stagnation and blood stasis syndrome.At this point,if the patient was willing to pay more than 6589.15 yuan,the probability of being more economical in the experimental group was better than that in the control group.Sensitivity analysis results showed that the basic analysis results of this study were robust.Conclusion:Based on the assumption that per capita disposable income in 2020 as the patients' personal willingness to pay the price,it is more economical to use Xueshuantong Injection(lyophilized) in combination with conventional treatment than conventional treatment alone in acute ischemic stroke patient with Qi stagnation and blood stasis syndrome.