吡格列酮治疗伴胰岛素抵抗非糖尿病缺血性卒中或短暂性脑缺血发作的成本效用分析

Cost-utility of pioglitazone for nondiabetic ischemic stroke or transient ischemic attack with insulin resistance

目的:评价在当前中国医疗环境下,伴胰岛素抵抗的非糖尿病缺血性卒中或短暂性脑缺血发作(TIA)后吡格列酮治疗的成本效用情况。方法:建立短期决策树模型和长期马尔可夫模型以评估卒中或TIA后吡格列酮治疗与非吡格列酮治疗的成本效用情况。采用临床试验数据、现有数据库分析、文献查阅等方法收集治疗效果、成本、健康效用、转移概率等模型参数,估计每个质量调整生命年(QALY)的短期和长期成本并进行单因素和概率敏感性分析,以模型拟合结果的稳定性。结果:与不使用吡格列酮治疗相比,吡格列酮治疗从第6年开始是值得的。吡格列酮治疗后30年增加0.129个QALY,增加成本6 990元,增量成本效果比(ICER)为54 186元·QALY^(-1)。概率敏感性分析显示,当意愿支付阈值为243 000元·QALY^(-1)时,吡格列酮治疗在99.9%的模型模拟中具有成本效果性。结论:在我国当前国情背景下,对于伴胰岛素抵抗非糖尿病缺血性卒中或TIA患者,使用吡格列酮治疗是值得的。

Objective:To estimate the cost-utility of pioglitazone treatment after nondiabetic stroke or transient ischemic attack(TIA) with insulin resistance.Methods:A short-run decision tree model and a long-run Markov model were developed to determine the cost-utility of pioglitazone treatment versus non-pioglitazone treatment after nondiabetic stroke or TIA.Outcomes,costs,utility and transfer proportion of the model were ccollected from the database and the literature.Short-term and lifetime costs per quality-adjusted life-years(QALYs) gained were estimated.One-way and multivariable probabilistic sensitivity analyses were performed to test the robustness of the results.Results:Comparing with non-pioglitazone treatment,pioglitazone treatment became cost-effective from the tenth year onwards.Pioglitazone treatment led to a lifetime(30-year) gain of 0.129 QALYs at an additional cost of CNY 6 990,yielding an ICER of CNY 54 186 per QALY gained.Probabilistic sensitivity analysis showed that pioglitazone treatment is cost-effective in 99.9% of the simulations at a willingness-to-pay threshold of CNY 243 000 per QALY.Conclusion:Pioglitazone treatment is cost-effective for nondiabetic stroke or TIA patients with insulin resistance in China.