“新四联”背景下伊伐布雷定治疗CHF的药物经济学评价

Pharmacoeconomics of ivabradine in the treatment of CHF in the context of“Quadruple Therapy”

目的从卫生体系角度出发,评价伊伐布雷定在“新四联”背景下治疗慢性心力衰竭(CHF)的经济性。方法基于真实世界队列研究数据,根据CHF疾病自然发展进程构建Markov模型,循环周期设为3个月,研究时限为20年,贴现率为5%;以质量调整生命年(QALY)和增量成本-效果比(ICER)为产出指标,采用成本-效用分析法评价伊伐布雷定联合“新四联”方案相较于“新四联”方案治疗CHF的经济性,并通过单因素敏感性分析、概率敏感性分析验证基础分析结果的稳健性。结果基础分析结果显示,伊伐布雷定联合“新四联”方案相较于“新四联”方案的ICER为165065.54元/QALY,低于以3倍我国2022年人均国内生产总值(GDP)作为的意愿支付(WTP)阈值(257094元/QALY)。单因素敏感性分析结果显示,贴现率对模型的稳健性影响最大。概率敏感性分析结果显示,在本研究的WTP阈值下,伊伐布雷定联合“新四联”方案具有经济性的概率为59.50%。结论当采用3倍我国2022年人均GDP(257094元/QALY)作为WTP阈值时,伊伐布雷定联合“新四联”方案治疗CHF具有经济性。

OBJECTIVE To evaluate the cost-effectiveness of ivabradine in the treatment of chronic heart failure(CHF)in the context of“Quadruple Therapy”from the perspective of the health system.METHODS Based on real-world cohort data,the Markov model was constructed according to the natural progression of CHF,with a cycle time of 3 months,a study timeframe of 20 years,and a discount rate of 5%.Using quality-adjusted life year(QALY)and incremental cost-effectiveness ratios(ICER)as the output indexes,the cost-utility analysis was used to evaluate the cost-effectiveness of ivabradine in combination with the“Quadruple Therapy”regimen,compared with the“Quadruple Therapy”regimen for the treatment of CHF,and the robustness of the results of the base analysis was verified by univariate sensitivity analysis and probabilistic sensitivity analysis.RESULTS The results of the base analysis showed that the ICER of ivabradine combined with the“Quadruple Therapy”regimen was 165065.54 yuan/QALY,compared with the“Quadruple Therapy”regimen,which was lower than the willingness-to-pay(WTP)threshold(257094 yuan/QALY)based on 3 times of China’s gross domestic product(GDP)per capita in 2022.The results of the univariate sensitivity analysis showed that the discount rate had the greatest impact on the robustness of the model.The probabilistic sensitivity analysis showed that the probability that the ivabradine combined with the“Quadruple Therapy”regimen was cost-effective under the WTP threshold in this study was 59.50%.CONCLUSIONS When using 3 times China’s 2022 GDP per capita(257094 yuan/QALY)as the WTP threshold,the combination of ivabradine and the“Quadruple Therapy”regimen for treating CHF is costeffective.