左西孟旦治疗冠状动脉旁路移植术后低心排出量综合征的成本-效果分析

Cost-Effectiveness Analysis of Levosimendan in the Treatment of Postoperative Low Cardiac Output Syndrome After Coronary Artery Bypass Grafting

目的从中国医疗保健体系角度,评估左西孟旦联合常规治疗方案(左西孟旦组)对比常规治疗方案(常规组)治疗冠状动脉旁路移植术(CABG)术后低心排出量综合征(LCOS)的成本-效果。方法基于一项国外多中心随机临床试验开展基础分析,成本参照新疆地区药品中标价和医疗服务收费标准,效用值参照国外已发表文献,构建决策树模型分析两方案的成本-效果,采用单因素、概率敏感性分析评估基础分析结果的稳健性。基于中国人群研究进行情景分析,分析方法同基础分析,评估两方案在中国人群中的成本-效果分析结果及其稳健性。结果基础分析表明:左西孟旦组对比常规组成本减少138.77元、效果增加0.000042个质量调整生命年(QALYs),具有绝对成本-效果优势,其敏感性分析表明某些成本及概率参数变动可能带来基础分析结果的偏差。情景分析表明:左西孟旦组对比常规组成本低(-2702.88元),效果相似(-0.000143 QALYs),未反转基础分析结果,其敏感性分析表明该情景分析结果具有稳健性。结论以中国医疗保健体系为研究角度,左西孟旦联合常规治疗方案对比常规治疗方案治疗CABG术后LCOS更有成本-效果优势,建议临床决策在考虑经济性时,优先使用左西孟旦联合常规治疗方案。

Objective To evaluate the cost-effectiveness of levosimendan combined with conventional treatment(the levosimendan group)versus conventional treatment(the conventional group)for patients with low cardiac output syndrome(LCOS)after coronary artery bypass grafting(CABG)from the perspective of the Chinese health-care system.Methods Based on a foreign multicentre randomised clinical trial,Basic case analysis was conducted with the cost referring to the bidding price of medicines and medical service charges in Xinjiang,and the utility value referring to the published literature in foreign countries,to analyze the cost-effectiveness of the two treatment protocols by developing a decision tree model using randomized control trail to estimate the clinical effects.One-way and probabilistic sensitivity analyses were performed to assess the robustness of the results.A scenario analysis was conducted with the same analytical approach using a cohort study for the Chinese population and their robustness.Results In the basic case analysis,the levosimendan group had an absolute cost-effectiveness advantage over the conventional group with a cost reduction of CNY 138.77 and an effect increase of 0.000042 quality-adjusted life years(QALYs)as a dominant strategy compared with conventional treatment.Its sensitivity analysis indicated that changes in some cost and probability parameters might introduce deviations in the results of the base-case analysis.In the scenario analysis,the levosimendan group had a relatively lower cost(-2702.88 CNY)and QALYs forgone(-0.000143 QALYs)to the conventional group,which did not reverse the results of the base-case analysis.Its sensitivity analysis showed the robustness of the results.Conclusion Using the Chinese healthcare system as a study perspective,levosimendan combined with conventional treatment regimens has more cost-effectiveness advantages than conventional treatment regimens for patients with postoperative LCOS after CABG.It is recommended that clinical decision-making should give priority to the use of levosimendan in combination with conventional treatment regimens when considering affordability.