基于ADRB2基因检测的汉族COPD患者使用干粉吸入剂治疗的成本效果分析
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摘要
目的对COPD患者使用干粉吸入剂(dry powder inhalers,DPIs)治疗前是否进行ADRB2基因检测进行成本-效果分析,为基于药物基因组学选用药品提供经济学参考。方法从全社会角度出发,构建决策树模型,基于ADRB2基因检测对汉族COPD患者进行DPIs治疗的医疗成本和效果进行计算,采用成本-效果分析方法评价其经济性,并进行敏感性分析。结果成本-效果分析结果显示,应用DPIs前进行ADRB2基因检测的治疗策略(ADRB2testing,AT)的期望总成本为12 170.78元,期望质量调整生命年(quality-adjusted life years,QALY)为0.411 8,成本效果比(cost-effectiveness ratio,CER)为29 555.08元/QALY;未进行基因检测(no testing,NT)的治疗策略期望总成本为11 711.01元,期望QALY为0.407 8,CER为28 717.53元/QALY。2种治疗策略的增量成本效果比(incremental cost effectiveness ratio,ICER)为114 942.96,低于本研究的意愿支付水平(2017年我国人均GDP的3倍,即177 785.28元),说明AT方案具有经济性。单因素敏感性分析表明,ADRB2基因检测价格、ADRB2基因多态性对ICER结果影响较大;概率敏感性分析表明,2种治疗策略相比,AT方案具有一定经济性,但优越性相对不明显。结论在意愿支付水平内,AT方案是经济学可以接受的方案,但敏感性分析结果尚不能确定哪一种方案为最优方案。
OBJECTIVE To compare the cost-effectiveness of using dry powder inhalers(DPIs) whether testing ADRB2 Genetic Polymorphisms in Chinese COPD patients, and to provide economical references for reasonable clinical prescription based Pharmacogenomics. METHODS From a society-wide perspective, a decision tree model was developed to calculate medical cost and health outcomes of using DPIs in Chinese COPD patients based testing ADRB2 genetic polymorphisms, cost-effectiveness analysis and sensitivity analysis were used to evaluate its economy. RESULTS The results of cost-effectiveness analysis showed that the expected cost of regimen of using DPIs by ADRB2 testing(AT) was 12 170.78 Yuan, the expected Quality-adjusted life years(QALY) was 0.411 8, and the cost effectiveness ratio(CER) was 29 555.08 Yuan/QALY. And the expected cost of regimen of using DPIs by no testing(NT) was 11 711.01 Yuan, the expected QALY was 0.407 8, CER of NT was 28 717.53 Yuan/QALY. The incremental cost-effectiveness ratio(ICER) of AT and NT regimen was 114 942.96, Less than the willingness to pay(WTP) set(3 times China's per capita GDP in 2017: 177 785.28 Yuan) in this study, it illustrated that AT regimen was economical. Results of single factor sensitivity analysis demonstrated that price of ADRB2 testing and ADRB2 genetic polymorphism had a greater impact on ICER results, probabilistic sensitivity analysis showed that AT regimen had more economical than NT regimen, but the superiority was relatively insignificant. CONCLUSION Within the level of WTP, AT regimen was an economically acceptable solution, however, sensitivity analysis result can not yet determine which regimen was the best one.
OBJECTIVE To compare the cost-effectiveness of using dry powder inhalers(DPIs) whether testing ADRB2 Genetic Polymorphisms in Chinese COPD patients, and to provide economical references for reasonable clinical prescription based Pharmacogenomics. METHODS From a society-wide perspective, a decision tree model was developed to calculate medical cost and health outcomes of using DPIs in Chinese COPD patients based testing ADRB2 genetic polymorphisms, cost-effectiveness analysis and sensitivity analysis were used to evaluate its economy. RESULTS The results of cost-effectiveness analysis showed that the expected cost of regimen of using DPIs by ADRB2 testing(AT) was 12 170.78 Yuan, the expected Quality-adjusted life years(QALY) was 0.411 8, and the cost effectiveness ratio(CER) was 29 555.08 Yuan/QALY. And the expected cost of regimen of using DPIs by no testing(NT) was 11 711.01 Yuan, the expected QALY was 0.407 8, CER of NT was 28 717.53 Yuan/QALY. The incremental cost-effectiveness ratio(ICER) of AT and NT regimen was 114 942.96, Less than the willingness to pay(WTP) set(3 times China's per capita GDP in 2017: 177 785.28 Yuan) in this study, it illustrated that AT regimen was economical. Results of single factor sensitivity analysis demonstrated that price of ADRB2 testing and ADRB2 genetic polymorphism had a greater impact on ICER results, probabilistic sensitivity analysis showed that AT regimen had more economical than NT regimen, but the superiority was relatively insignificant. CONCLUSION Within the level of WTP, AT regimen was an economically acceptable solution, however, sensitivity analysis result can not yet determine which regimen was the best one.
引文
[1]GOLD 2017 Global Strategy for the Diagnosis,Management and Prevention of COPD-Global Initiative for Chronic Obstructive Lung Disease-GOLD[EB/OL].2017-10-23.http://goldcopd.org/gold-2017-global-strategy-diagnosis-managem ent-prevention-copd/.
[2]STARKIE H J,BRIGGS A H,CHAMBERS M G.Pharmacoeconomics in COPD:Lessons for the Future[J].Int JChron Obstruct Pulmon Dis,2008,3(1):71-88.
[3]BLEECKER E R,MEYERS D A,BAILEY W C,et al.ADRB2 polymorphisms and budesonide/formoterol responses in COPD[J].Chest,2012,142(2):320-328.
[4]YELENSKY R,LI Y,LEWITZKY S,et al.Apharmacogenetic study of ADRB2 polymorphisms and indacaterol response in COPD patients[J].Pharmacogenomics J,2012,12(6):484-488.
[5]WANG W,LI P,CHEN Y,et al.Association betweenβ2-adrenergic receptor-16Arg/Gly gene polymorphism and chronic obstructive pulmonary disease risk:systematic review and meta-analysis[J].Iran J Public Health,2014,43(7):877-888.
[6]LIN Q,ZHENG L L,LIN J,et al.Difference in the clinical efficacy of Chinese COPD patients using different dry powder inhalers-a comparison based on pharmacogenomics[J].JPutian Univ(莆田学院学报),2017,24(5):11-13.
[7]SIN D D,STAFINSKI T,NG Y C,et al.The impact of chronic obstructive pulmonary disease on work loss in the united states[J].Am J Respir Crit Care Med,2002,165(5):704-707.
[8]PRICE D,KEININGER D,COSTA-SCHARPLATZ M,et al.Cost-effectiveness of the LABA/LAMA dual bronchodilator indacaterol/glycopyrronium in a Swedish healthcare setting[J].Respir Med,2014,108(12):1786-1793.
[9]RUTTEN-VAN M?LKEN M P,OOSTENBRINK J B,TASHKIN D P,et al.Does quality of life of copd patients as measured by the generic euroqol five-dimension questionnaire differentiate between copd severity stages?[J].CHEST,2006,130(4):1117-1128.
[10]MAXWELL T J,AMEYAW M M,PRITCHARD S,et al.Beta-2 adrenergic receptor genotypes and haplotypes in different ethnic groups[J].Int J Mol Med,2005,16(4):573-580.
[11]TANG W Y,ZHAO Z H,JIANG Y F.Cardiovascular safety for therapeutic drugs of chronic obstructive pulmonary disease[J].Chin J New Drug Clin Rem(中国新药与临床杂志),2017,36(1):16-19.
[12]WANG H Y,HE J J,LIN X.Pharmacoeconomics of budesonide/formoterol versus fluticasone/salmeterol for asthma:A systematic review[J].China Pharm(中国药房),2015,26(18):2527-2529.
[13]薛原.噻托溴铵和沙美特罗治疗慢性阻塞性肺疾病的药物经济学评价综述[J].中国药物经济学,2016,4(11):12-15.
[2]STARKIE H J,BRIGGS A H,CHAMBERS M G.Pharmacoeconomics in COPD:Lessons for the Future[J].Int JChron Obstruct Pulmon Dis,2008,3(1):71-88.
[3]BLEECKER E R,MEYERS D A,BAILEY W C,et al.ADRB2 polymorphisms and budesonide/formoterol responses in COPD[J].Chest,2012,142(2):320-328.
[4]YELENSKY R,LI Y,LEWITZKY S,et al.Apharmacogenetic study of ADRB2 polymorphisms and indacaterol response in COPD patients[J].Pharmacogenomics J,2012,12(6):484-488.
[5]WANG W,LI P,CHEN Y,et al.Association betweenβ2-adrenergic receptor-16Arg/Gly gene polymorphism and chronic obstructive pulmonary disease risk:systematic review and meta-analysis[J].Iran J Public Health,2014,43(7):877-888.
[6]LIN Q,ZHENG L L,LIN J,et al.Difference in the clinical efficacy of Chinese COPD patients using different dry powder inhalers-a comparison based on pharmacogenomics[J].JPutian Univ(莆田学院学报),2017,24(5):11-13.
[7]SIN D D,STAFINSKI T,NG Y C,et al.The impact of chronic obstructive pulmonary disease on work loss in the united states[J].Am J Respir Crit Care Med,2002,165(5):704-707.
[8]PRICE D,KEININGER D,COSTA-SCHARPLATZ M,et al.Cost-effectiveness of the LABA/LAMA dual bronchodilator indacaterol/glycopyrronium in a Swedish healthcare setting[J].Respir Med,2014,108(12):1786-1793.
[9]RUTTEN-VAN M?LKEN M P,OOSTENBRINK J B,TASHKIN D P,et al.Does quality of life of copd patients as measured by the generic euroqol five-dimension questionnaire differentiate between copd severity stages?[J].CHEST,2006,130(4):1117-1128.
[10]MAXWELL T J,AMEYAW M M,PRITCHARD S,et al.Beta-2 adrenergic receptor genotypes and haplotypes in different ethnic groups[J].Int J Mol Med,2005,16(4):573-580.
[11]TANG W Y,ZHAO Z H,JIANG Y F.Cardiovascular safety for therapeutic drugs of chronic obstructive pulmonary disease[J].Chin J New Drug Clin Rem(中国新药与临床杂志),2017,36(1):16-19.
[12]WANG H Y,HE J J,LIN X.Pharmacoeconomics of budesonide/formoterol versus fluticasone/salmeterol for asthma:A systematic review[J].China Pharm(中国药房),2015,26(18):2527-2529.
[13]薛原.噻托溴铵和沙美特罗治疗慢性阻塞性肺疾病的药物经济学评价综述[J].中国药物经济学,2016,4(11):12-15.
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