重组人血小板生成素联合常规方案治疗脓毒症相关血小板减少症的成本-效果分析

Cost-effectiveness Analysis of Recombinant Human Thrombopoietin Combined with Conventional Regimen in the Treatment of Sepsis-Associated Thrombocytopeni

目的:从我国卫生服务体系角度出发,评估重组人血小板生成素(rhTPO)联合常规治疗对比常规治疗在脓毒症相关血小板减少症(SIT)治疗中的经济性。方法:构建决策树模型,基于脓毒症疾病特点采用最小成本分析和成本-效果分析两种方法进行经济性评价,并通过两种意愿支付阈值判断其经济性,再以敏感性分析检验结果的稳定性。结果:rhTPO联用常规治疗相比于单用常规疗法每提高1%的存活率患者可以节省520.58元,为绝对优势方案。单因素敏感性分析显示,对照组ICU医疗服务日成本和连续性肾脏替代治疗(CRRT)使用时长、试验组ICU医疗服务日成本对结果影响较大,参数结局稳定性较好。概率敏感性分析显示,意愿支付阈值在0~268074元间变动时,rhTPO具有经济性的概率为100%。结论:在现有证据下,rhTPO联合常规治疗用于SIT治疗在提升存活率且同等安全的基础上更具有经济性。

Objective:To evaluate the economy of recombinant human thrombopoietin(rhTPO)combined with conventional therapy compared with conventional therapy in the treatment of sepsis-associated thrombocytopenia(SIT)from the perspective of China's health service system.Methods:The decision tree model was constructed,and the minimum cost analysis and cost-effectiveness analysis were used to evaluate the economy based on the characteristics of sepsis.The economy was judged by two willingness to pay thresholds,and then the stability of the results was tested by sensitivity analysis.Results:rhTPO combined with conventional therapy can save 520.58 yuan for each 1%increase in survival rate compared with conventional therapy alone,which is an absolute advantage program.The single factor sensitivity analysis showed that the daily cost of ICU medical service and the duration of CRRT in the control group and the daily cost of ICU medical service in the experimental group had a great influence on the results,and the stability of the parameter outcome was good.The probability sensitivity analysis showed that when the willingness to pay threshold changes ranged 0~268074 yuan,rhTPO has a 100%economical probability.Conclusion:Under the existing evidence,rhTPO combined with conventional treatment for SIT treatment is more economical on the basis of improving survival rate and equal safety.