应用Markov模型对3种血管紧张素Ⅱ受体拮抗剂预防高血压患者卒中和心肌梗死的经济学评价
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摘要
目的本研究采用Markov模型对坎地沙坦酯、厄贝沙坦和替米沙坦预防高血压患者卒中和心肌梗死事件进行长期经济学评价,为高血压药物干预提供依据。方法根据高血压疾病自然史构建Markov模型,从全社会角度预测不同治疗方案下患者的医疗费用和获得的质量调整生命年(quality adjusted life years,QALYs),并计算增量成本效果比(incremental cost-effectiveness ratio,ICER)。模型循环周期为1年,研究时限为20年。医疗费用和QALYs均采用5%的贴现率。在此基础上分别进行单因素敏感性、二阶Monte-Carlo模拟和概率敏感性分析。结果基线分析中,坎地沙坦酯由于成本最高而效果最低,处于绝对劣势;厄贝沙坦相较于替米沙坦的增量成本效果比ICER是5 799. 67元/QALY。敏感性分析与基线结果一致。结论与替米沙坦相比,在阈值为49 992元/QALY时,厄贝沙坦具有明显经济学优势;而与这两者相比,坎地沙坦酯均不具有经济性。
OBJECTIVE To investigate the long-term economic consequences of candesartan cilexetil、irbesartan and telmisartan in preventing stroke and myocardial infarction( MI) among hypertension patients using Markov model,to offer the reference for hypertension intervention. METHODS A Markov state transition model was built based on the natural history of hypertension from the societal perspective to estimate the expected health care costs and the quality adjusted life years. Meanwhile,the incremental cost-effectiveness ratio was obtained. One year cycle length and 20 years horizon were adopted. The 5% yearly discount rate was applied to both health care costs and QALYs. One-way sensitivity analysis,second-order Monte-Carlo and probabilistic sensitivity analysis were performed. RESULTS Candesartan cilexetil was at an absolute disadvantage because of the highest cost and the lowest effect in the baseline analysis. The incremental cost-effectiveness ratio for irbesartan versus telmisartan was 5 799. 67 yuan/QALY. The sensitivity analysis was consistent with the baseline results. CONCLUSION Irbesartan shows significant economic advantage at the threshold of 49 992 yuan/QALY compared with telmisartan. And candesartan cilexetil is with less economical.
OBJECTIVE To investigate the long-term economic consequences of candesartan cilexetil、irbesartan and telmisartan in preventing stroke and myocardial infarction( MI) among hypertension patients using Markov model,to offer the reference for hypertension intervention. METHODS A Markov state transition model was built based on the natural history of hypertension from the societal perspective to estimate the expected health care costs and the quality adjusted life years. Meanwhile,the incremental cost-effectiveness ratio was obtained. One year cycle length and 20 years horizon were adopted. The 5% yearly discount rate was applied to both health care costs and QALYs. One-way sensitivity analysis,second-order Monte-Carlo and probabilistic sensitivity analysis were performed. RESULTS Candesartan cilexetil was at an absolute disadvantage because of the highest cost and the lowest effect in the baseline analysis. The incremental cost-effectiveness ratio for irbesartan versus telmisartan was 5 799. 67 yuan/QALY. The sensitivity analysis was consistent with the baseline results. CONCLUSION Irbesartan shows significant economic advantage at the threshold of 49 992 yuan/QALY compared with telmisartan. And candesartan cilexetil is with less economical.
引文
[1] COOPER R S,KAUFMAN J S,BOVET P. Global burden of disease attributable to hypertension[J]. Am Med Assoc,2017,317(19):2017-2018.
[2] EOIN O'BRIEN M D,FRCP D S C. The lancet commission on hypertension:addressing the global burden of raised blood pressure on current and future generations[J]. J Clin Hypertens(Greenwich),2017,19(6):564-568.
[3] LIU Y. Hypertension and community health education(review)[J]. Contin Med Educ,2011,25(9):64-66.
[4] ZOU J M,LI R J. Epidemiological research progress and risk factors analysis of hypertension[J]. Chin J Conval Med(中国疗养医学),2013,22(9):796-798.
[5] WANG A,LIU X,SU Z,et al. Two-year changes in proteinuria and risk for myocardial infarction in patients with hypertension:a prospective cohort study[J]. J Hyper,2017,35(11):2295-2302.
[6] LAWES C M M,HOORN S V,RODGERS A,et al. Global burden of blood-pressure related disease,2001[J]. Lancet,2008,371(9623):1513-1518.
[7] VENKETASUBRAMANIAN N,YOON B W,PANDIAN J,et al.Stroke epidemiology in south,east,and south-east asia:a review[J]. J Stroke,2017,19(3):286-294.
[8] THOMOPOULOS C,PARATI G,ZANCHETTI A. Effects of blood-pressure-lowering treatment in hypertension:9. Discontinuations for adverse events attributed to different classes of antihypertensive drugs:Meta-analyses of randomized trials[J]. J Hyper,2016,34(10):1921-1932.
[9] ZHANG C X,HAN B G. A Meta analysis of irbesartan and telmisartan in lowering blood pressure[J]. Strait Pharm J(海峡药学),2016,28(9):91-92.
[10] DEVLIN N,PARKIN D. Does NICE have a cost-effectiveness threshold and what other factors influence its decisions? A binary choice analysis[J]. Health Econ,2004,13(5):437-452.
[11] World Health Organization:Macroeconomics and health:investing in health for economic development. Report of the commission on macroeconomics and health. In Book WHO commission on macroeconomics and health:macroeconomics and health:investing in health for economic development[EB/OL].[2018-01-10]. http://whqlibdoc. who. int/publications/2001/924154550x. pdf,accessed September 2012.
[12] WU Y,ZHOU Q,XUAN J,et al. A cost-effectiveness analysis between amlodipine and angiotensinⅡreceptor blockers in stroke and myocardial infarction prevention among hypertension patients in China[J]. Value Health Reg Issues,2013,2(1):75-80.
[13] YOU R X,LIU J Y,ZHANG Y,et al. The long-term pharmacoeconomic evaluation of irbesartan and bisoprolol in hypertension with heart failure using Markov model[J]. Chin Pharm J(中国药学杂志),2017,52(24):2209-2213.
[14] STEVANOVIC J,O'PRINSEN A C,VERHEGGEN B G,et al.Economic evaluation of primary prevention of cardiovascular diseases in mild hypertension:a scenario analysis for the Netherlands[J]. Clin Ther,2014,36(3):368-84. e5.
[15] GU D,HE J,COXSON P G,et al. The cost-effectiveness of low-cost essential antihypertensive medicines for hypertension control in China:a modelling study[J]. PLoS Med,2015,12(8):e1001860.
[16] PAPADEMETRIOU V,FARSANG C,ELMFELDT D,et al.Stroke prevention with the angiotensinⅡtype 1-receptor blocker candesartan cilexetil in elderly patients with isolated systolic hypertension:the study on cognition and prognosis in the elderly(SCOPE)[J]. J Am Coll Cardiol,2004,44(6):1175-1180.
[17] BRIGGS A,SCULPHER M. An introduction to Markov modeling for economic evaluation[J]. Pharmacoeconomics,1998,13(4):397-409.
[18] DIANA B,PETITTI D. Meta-Analysis,Decision Analysis,and Cost-effectiveness Analysis[M]. 2nd Ed. New York:Oxford University Press,2000.
[19] TSOI B,AKIOYAMEN L E,BONNER A,et al. Comparative efficacy of angiotensinⅡantagonists in essential hypertension:systematic review and network Meta-analysis of randomised controlled trials[J]. Heart Lung Circ,2018,27(6):666-682.
[20] THORVALDSEN P,KUULASMAA K,RAJAKANGAS A M,et al. Stroke trends in the WHO MONICA project[J]. Stroke,1997,28(3):500-506.
[21] JIANG S L,JI X P,WANG Y,et al. Impact of gender on inhospital death in hospitalized patients with acute myocardial infarction[J]. Chin J Cardial(中华心血管病杂志),2008,36(7):590-593.
[22] The 6th China national population census. Available from:http://www. stats. gov. cn/tjsj/pcsj/rkpc/6rp/indexch. htm
[23] SUN Y,HUANG H B,ZHANG H. Direct medical costs and influencing factors for cerebral infarct[J]. Proc Clin Med(临床医药实践),2013,22(1):16-18,41.
[24] The Ministry of health of People's Republic of China. 2016 China Health Statistics Yearbook.
[25] GU Q,MA J,LI N,et al. Analysis of hospital expenditure and influencing factors of patients with acute myocardial infarction[J]. J Shanghai Jiaotong Univ(Med Sci)(上海交通大学学报:医学版),2013,33(6):746-750.
[26] SUN S,CHEN J,JOHANNESSON M,et al. Population health status in China:EQ-5D results,by age,sex and socio-economic status,from the national health services survey 2008[J]. Qual Life Res,2011,20(3):309-320.
[27] ARA R,TUMUR I,PANDOR A,et al. Ezetimibe for the treatment of hypercholesterolaemia:a systematic review and economic evaluation[J]. Health Technol Assess,2008,12(21):iii,xixiii,1-212.
[28] LIU G E. China Guidelines for Pharmacoeconomic Evaluations and Manual:2015 Edition(中国药物经济学评价指南及导读. 2015年版)[M]. Beijing:Science Press,2014.
[29] NAIMARK D M,BOTT M,KRAHN M. The half-cycle correction explained:two alternative pedagogical approaches[J]. Med Dec Making/SEP,2008,28(5):706-712.
[30] FOROUZANFAR M H,LIU P,ROTH G A,et al. Global burden of hypertension and systolic blood pressure of at least 110 to115 mm Hg,1990-2015[J]. Am Med Assoc,2017,317(2):165-182.
[31] OGIHARA T,UESHIMA K,NAKAO K,et al. Long-term effects of candesartan cilexetil and amlodipine on cardiovascular morbidity and mortality in Japanese high-risk hypertensive patients:the candesartan cilexetil antihypertensive survival evaluation in Japan extension study(CASE-J Ex)[J]. Hyper Res,2011,34(12):1295-1301.
[2] EOIN O'BRIEN M D,FRCP D S C. The lancet commission on hypertension:addressing the global burden of raised blood pressure on current and future generations[J]. J Clin Hypertens(Greenwich),2017,19(6):564-568.
[3] LIU Y. Hypertension and community health education(review)[J]. Contin Med Educ,2011,25(9):64-66.
[4] ZOU J M,LI R J. Epidemiological research progress and risk factors analysis of hypertension[J]. Chin J Conval Med(中国疗养医学),2013,22(9):796-798.
[5] WANG A,LIU X,SU Z,et al. Two-year changes in proteinuria and risk for myocardial infarction in patients with hypertension:a prospective cohort study[J]. J Hyper,2017,35(11):2295-2302.
[6] LAWES C M M,HOORN S V,RODGERS A,et al. Global burden of blood-pressure related disease,2001[J]. Lancet,2008,371(9623):1513-1518.
[7] VENKETASUBRAMANIAN N,YOON B W,PANDIAN J,et al.Stroke epidemiology in south,east,and south-east asia:a review[J]. J Stroke,2017,19(3):286-294.
[8] THOMOPOULOS C,PARATI G,ZANCHETTI A. Effects of blood-pressure-lowering treatment in hypertension:9. Discontinuations for adverse events attributed to different classes of antihypertensive drugs:Meta-analyses of randomized trials[J]. J Hyper,2016,34(10):1921-1932.
[9] ZHANG C X,HAN B G. A Meta analysis of irbesartan and telmisartan in lowering blood pressure[J]. Strait Pharm J(海峡药学),2016,28(9):91-92.
[10] DEVLIN N,PARKIN D. Does NICE have a cost-effectiveness threshold and what other factors influence its decisions? A binary choice analysis[J]. Health Econ,2004,13(5):437-452.
[11] World Health Organization:Macroeconomics and health:investing in health for economic development. Report of the commission on macroeconomics and health. In Book WHO commission on macroeconomics and health:macroeconomics and health:investing in health for economic development[EB/OL].[2018-01-10]. http://whqlibdoc. who. int/publications/2001/924154550x. pdf,accessed September 2012.
[12] WU Y,ZHOU Q,XUAN J,et al. A cost-effectiveness analysis between amlodipine and angiotensinⅡreceptor blockers in stroke and myocardial infarction prevention among hypertension patients in China[J]. Value Health Reg Issues,2013,2(1):75-80.
[13] YOU R X,LIU J Y,ZHANG Y,et al. The long-term pharmacoeconomic evaluation of irbesartan and bisoprolol in hypertension with heart failure using Markov model[J]. Chin Pharm J(中国药学杂志),2017,52(24):2209-2213.
[14] STEVANOVIC J,O'PRINSEN A C,VERHEGGEN B G,et al.Economic evaluation of primary prevention of cardiovascular diseases in mild hypertension:a scenario analysis for the Netherlands[J]. Clin Ther,2014,36(3):368-84. e5.
[15] GU D,HE J,COXSON P G,et al. The cost-effectiveness of low-cost essential antihypertensive medicines for hypertension control in China:a modelling study[J]. PLoS Med,2015,12(8):e1001860.
[16] PAPADEMETRIOU V,FARSANG C,ELMFELDT D,et al.Stroke prevention with the angiotensinⅡtype 1-receptor blocker candesartan cilexetil in elderly patients with isolated systolic hypertension:the study on cognition and prognosis in the elderly(SCOPE)[J]. J Am Coll Cardiol,2004,44(6):1175-1180.
[17] BRIGGS A,SCULPHER M. An introduction to Markov modeling for economic evaluation[J]. Pharmacoeconomics,1998,13(4):397-409.
[18] DIANA B,PETITTI D. Meta-Analysis,Decision Analysis,and Cost-effectiveness Analysis[M]. 2nd Ed. New York:Oxford University Press,2000.
[19] TSOI B,AKIOYAMEN L E,BONNER A,et al. Comparative efficacy of angiotensinⅡantagonists in essential hypertension:systematic review and network Meta-analysis of randomised controlled trials[J]. Heart Lung Circ,2018,27(6):666-682.
[20] THORVALDSEN P,KUULASMAA K,RAJAKANGAS A M,et al. Stroke trends in the WHO MONICA project[J]. Stroke,1997,28(3):500-506.
[21] JIANG S L,JI X P,WANG Y,et al. Impact of gender on inhospital death in hospitalized patients with acute myocardial infarction[J]. Chin J Cardial(中华心血管病杂志),2008,36(7):590-593.
[22] The 6th China national population census. Available from:http://www. stats. gov. cn/tjsj/pcsj/rkpc/6rp/indexch. htm
[23] SUN Y,HUANG H B,ZHANG H. Direct medical costs and influencing factors for cerebral infarct[J]. Proc Clin Med(临床医药实践),2013,22(1):16-18,41.
[24] The Ministry of health of People's Republic of China. 2016 China Health Statistics Yearbook.
[25] GU Q,MA J,LI N,et al. Analysis of hospital expenditure and influencing factors of patients with acute myocardial infarction[J]. J Shanghai Jiaotong Univ(Med Sci)(上海交通大学学报:医学版),2013,33(6):746-750.
[26] SUN S,CHEN J,JOHANNESSON M,et al. Population health status in China:EQ-5D results,by age,sex and socio-economic status,from the national health services survey 2008[J]. Qual Life Res,2011,20(3):309-320.
[27] ARA R,TUMUR I,PANDOR A,et al. Ezetimibe for the treatment of hypercholesterolaemia:a systematic review and economic evaluation[J]. Health Technol Assess,2008,12(21):iii,xixiii,1-212.
[28] LIU G E. China Guidelines for Pharmacoeconomic Evaluations and Manual:2015 Edition(中国药物经济学评价指南及导读. 2015年版)[M]. Beijing:Science Press,2014.
[29] NAIMARK D M,BOTT M,KRAHN M. The half-cycle correction explained:two alternative pedagogical approaches[J]. Med Dec Making/SEP,2008,28(5):706-712.
[30] FOROUZANFAR M H,LIU P,ROTH G A,et al. Global burden of hypertension and systolic blood pressure of at least 110 to115 mm Hg,1990-2015[J]. Am Med Assoc,2017,317(2):165-182.
[31] OGIHARA T,UESHIMA K,NAKAO K,et al. Long-term effects of candesartan cilexetil and amlodipine on cardiovascular morbidity and mortality in Japanese high-risk hypertensive patients:the candesartan cilexetil antihypertensive survival evaluation in Japan extension study(CASE-J Ex)[J]. Hyper Res,2011,34(12):1295-1301.