噻托溴铵/奥达特罗与噻托溴铵治疗中至极重度慢性阻塞性肺疾病的药物经济学评价

Economic Evaluation of Tiotropium/Olodaterol and Tiotropium in the Treatment of Moderate to Very Severe Chronic Obstructive Pulmonary Disease

目的评价噻托溴铵/奥达特罗治疗中至极重度慢性阻塞性肺疾病(COPD)患者的经济性,为临床选择更具有经济性的吸入制剂提供参考。方法构建四状态Markov模型,循环周期为3个月,健康产出指标为生命年(LY)和质量调整生命年(QALY)。模型模拟时间为终身。从中国卫生体系角度计算成本,包括直接医疗成本。停药率利用GetData Graph Digitizer软件从停药曲线中获取。通过队列模拟结果计算增量成本效用比来判断经济性。通过敏感性分析探讨参数与模型的差异性与不确定性对基础分析结果的影响,以此评价研究结果的稳健性。结果与噻托溴铵相比,使用噻托溴铵/奥达特罗治疗,平均每例患者增加了0.0846 LY,同时增加了3201.50元成本和0.0296 QALY,增量成本效用比为每QALY108140.11元,低于2021年中国3倍人均国内生产总值(GDP)的意愿支付(WTP)阈值。单因素敏感性分析显示,对结果影响最大的参数是2种药品的价格;概率敏感性分析结果显示,在3倍人均GDP的WTP阈值下,噻托溴铵/奥达特罗更有经济性的概率是93.8%。结论对于中至极重度COPD患者,与噻托溴铵相比,噻托溴铵/奥达特罗更具有经济性,且该结果在敏感性分析中十分稳健。

Objective To evaluate the cost-utility of tiotropium/olodaterol in treating Chinese patients with moderate to very severe chronic obstructive pulmonary disease(COPD)and to provide references for selecting more economical inhaled preparations in clinical practice.Methods A four-state lifetime Markov model was established with a 3-month cycle.The health outcomes included life years and quality-adjusted life years.Costs,including direct medical costs,were calculated from the perspective of the Chinese health system.Discontinuation rates were derived from the discontinuation curve using GetData Graph Digitizer.The main output indicator of the model was the incremental cost-utility ratio,which was calculated from the queue simulation results to judge the economy of tiotropium bromide/odataterol.The scenario analysis and sensitivity analyses were carried out to detect the robustness of the base case result.Results Compared with tiotropium bromide,the patient treated with tiotropium bromide/odataterol gained an additional 0.0846 life years,an additional cost of￥3201.50,and additional 0.0296 QALY.The incremental cost-utility ratio was 108140.11 yuan/QALY,lower than the willingness-to-pay threshold of three times China's per capita GDP in 2021.The costs of tiotropium bromide and tiotropium bromide/odataterol had the greatest impact on the result in the one-way sensitivity analysis.93.8%of the Chinese COPD population was willing to pay for tiotropium bromide/odataterol under the threshold in the probability sensitivity analysis.Conclusion Tiotropium/olodaterol is a cost-effective alternative compared to tiotropium for patients with moderate to very severe COPD in China and the results were robust in the sensitivity analyses.