达格列净治疗射血分数降低型心力衰竭的成本-效益

Cost-effectiveness of Dapagliflozin in the Treatment of Heart Failure with Reduced Ejection Fraction

目的评价添加达格列净治疗中国射血分数降低型心力衰竭(HFrEF)患者的成本-效益。方法基于DAPA-HF试验数据和相关文献,构建循环周期为3个月、时限为10年的多状态Markov模型,以医疗卫生系统为研究角度,根据是否添加达格列净,分为达格列净组和对照组,模拟添加达格列净治疗HFrEF患者的质量调整生命年(QALYs)和直接医疗成本,比较两组增量成本-效果比(ICER),并用敏感性分析验证结果的稳健性。结果与标准治疗方案相比,添加达格列净治疗中国HFrEF患者增加0.46 QALYs,直接医疗总成本增加9976.01元,ICER值为21649.33元/QALY,低于我国2022年的人均国内生产总值(GDP)85698元;单因素敏感性分析显示对照组的心血管死亡下限值对ICER值影响最大,概率敏感性分析显示在意愿支付(WTP)阈值为85698元/QALY时,添加达格列净具有经济性的概率为70.4%。结论在我国标准治疗方案基础上添加达格列净治疗HFrEF极具成本-效益。

Objective To evaluate the cost-effectiveness of addition of Dapagliflozin in the treatment of Chinese patients with reduced ejection fraction heart failure.Methods Based on DAPA-HF test data and related literature,a multi-state Markov model with a cycle period of 3 months and a time period of 10 years was established.Taking the health care system as the research perspective,Dapagliflozin group and control group were divided according to whether Dapagliflozin was added or not.The quality-adjusted life years(QALYs)and direct medical costs of addition of Dapagliflozin in Chinese patients with reduced ejection fraction heart failure were simulated.The primary outcome was the cost-effectiveness ratio(ICER),and the robustness of the results was verified by sensitivity analysis.Results Compared with the standard treatment regimen,the addition of Dapagliflozin in the treatment of HFrEF patients in China increased by 0.46 QALYs,the total direct medical cost increased by 9976.01 yuan,and the ICER value was 21649.33 yuan/QALY,which was lower than the per capita gross domestic product(GDP)of China in 2022 of 85698 yuan.Single-factor sensitivity analysis showed that the lower limit of cardiovascular death in the control group had the greatest impact on ICER value,and probability sensitivity analysis showed that when the WTP threshold was 85698 yuan/QALY,the economic probability of adding Dapagliflozin was 70.4%.Conclusion The Dapagliflozin of Dapagliflozin in the treatment of HFrEF on the basis of our standard treatment regimen is very cost-effective.