引入Markov模型对调脂药进行药物经济学评价研究
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摘要
目的：引入Markov模型对脂必妥与辛伐他汀治疗高脂血症进行药物经济学研究,评价高脂血症安全、有效、具有经济性的用药方案,指导临床合理用药。
方法：1.Markov模型分析法：建立脂必妥与辛伐他汀治疗高脂血症的Markov模型,分别对脂必妥与辛伐他汀两种药物治疗高脂血症患者无事件、非致死性心肌梗死、非致死性冠心病和死亡的动态变化进行模拟。
2.运用Markov模型进行回乘分析、队列模拟获得脂必妥与辛伐他汀治疗高脂血症的长期效果与成本,同时对成本、效用值进行敏感度分析,找出临床相对较优的治疗药物。
结果：Markov模型成本-效果分析显示,3%的贴现率下脂必妥治疗高脂血10年所需成本为37900元,相比辛伐他汀治疗组少花3700元；质量调整生命年为6.063年,比辛伐他汀治疗组延长0.093年；成本-效果比为6247元/质量调整生命年,脂必妥治疗组优于辛伐他汀治疗组。以2011年中国人均GDP作为阀值标准,脂必妥治疗方案的成本效果比低于阀值标准,脂必妥为相对较优治疗方案。敏感度分析显示各参数在设定的范围内变化不影响模型分析结论。
结论：脂必妥与辛伐他汀治疗组相比,脂必妥治疗组的成本效果优于辛伐他汀治疗组,因此,应优先选择脂必妥作为调节血脂的治疗药物,从而获得更优的经济学效益,使有限的医疗资源利用最大化。本研究引入Markov模型对调脂药进行药物经济学评价,可为国内调脂药的药物经济学评价提供方法学上的借鉴。由于国内尚缺乏相关报道,本研究基线数据来源于国外资料,因此,今后只要得到相关临床研究资料,就应对本研究的结果重新进行评估。
OBJECTIVES:The cost-effectiveness analysis of Zhibituo and simvastatin using Markov model was performed for the purpose of choosing a secure and effective therapy for hyperlipemia.
METHODS:
1.Markov model analysis:Built Markov state transition model to simulate the dynamic changes of the four states(event free,non-fatal myocardial infatction,non-fatal stoke and death) in the hyperlipemia patients who received the Zhibituo or simvastatin treatment.
2.We had applied Markov model using Roll back analysis、Markov cohort simulation to project the costs and effectiveness for the hyperlipemia who had been long-term treated with Zhibituo or simvastatin.One way sensitivity analysis was carried out to determine the robustness of this baseline results.
RESULTS:
Markov model analysis results:The results of cost-effectiveness analysis showed that patients receiving simvastatin cumulative costs and effects were41600yuan and5.97quality-adjusted life years gained.Patients receiving zhibituo cumulative costs and effects were37900yuan and6.063quality-adjusted life years gained and the CER was6247yuan/QALYs. The analysis which used the2011per capita GDP35000yuan as the threshold standard and Zhibituo therapy for incremental analysis showed that Zhibituo was the better treatment. According to the sensitivity analysis, the change of key parameters in the set range did non affect the model results.
CONCLUSION:
In conclusion, Zhibituo treatment was more economical than simvastatin treatment for hyperlipemia patients.Compared to simvastatin treatment,Zhibituo treatment seemed prolonging the life of hyperlipemia patients.This study could be used as methodology reference of pharmacoeconomics on the hyperlipemia diseases for Chinese pharmacoeconomist.The baseline data about transition probability based on foreign research.So the findings of this study should be re-evaluated as soon as additional evidence becomes available from the clinical and economic studies.
方法：1.Markov模型分析法：建立脂必妥与辛伐他汀治疗高脂血症的Markov模型,分别对脂必妥与辛伐他汀两种药物治疗高脂血症患者无事件、非致死性心肌梗死、非致死性冠心病和死亡的动态变化进行模拟。
2.运用Markov模型进行回乘分析、队列模拟获得脂必妥与辛伐他汀治疗高脂血症的长期效果与成本,同时对成本、效用值进行敏感度分析,找出临床相对较优的治疗药物。
结果：Markov模型成本-效果分析显示,3%的贴现率下脂必妥治疗高脂血10年所需成本为37900元,相比辛伐他汀治疗组少花3700元；质量调整生命年为6.063年,比辛伐他汀治疗组延长0.093年；成本-效果比为6247元/质量调整生命年,脂必妥治疗组优于辛伐他汀治疗组。以2011年中国人均GDP作为阀值标准,脂必妥治疗方案的成本效果比低于阀值标准,脂必妥为相对较优治疗方案。敏感度分析显示各参数在设定的范围内变化不影响模型分析结论。
结论：脂必妥与辛伐他汀治疗组相比,脂必妥治疗组的成本效果优于辛伐他汀治疗组,因此,应优先选择脂必妥作为调节血脂的治疗药物,从而获得更优的经济学效益,使有限的医疗资源利用最大化。本研究引入Markov模型对调脂药进行药物经济学评价,可为国内调脂药的药物经济学评价提供方法学上的借鉴。由于国内尚缺乏相关报道,本研究基线数据来源于国外资料,因此,今后只要得到相关临床研究资料,就应对本研究的结果重新进行评估。
OBJECTIVES:The cost-effectiveness analysis of Zhibituo and simvastatin using Markov model was performed for the purpose of choosing a secure and effective therapy for hyperlipemia.
METHODS:
1.Markov model analysis:Built Markov state transition model to simulate the dynamic changes of the four states(event free,non-fatal myocardial infatction,non-fatal stoke and death) in the hyperlipemia patients who received the Zhibituo or simvastatin treatment.
2.We had applied Markov model using Roll back analysis、Markov cohort simulation to project the costs and effectiveness for the hyperlipemia who had been long-term treated with Zhibituo or simvastatin.One way sensitivity analysis was carried out to determine the robustness of this baseline results.
RESULTS:
Markov model analysis results:The results of cost-effectiveness analysis showed that patients receiving simvastatin cumulative costs and effects were41600yuan and5.97quality-adjusted life years gained.Patients receiving zhibituo cumulative costs and effects were37900yuan and6.063quality-adjusted life years gained and the CER was6247yuan/QALYs. The analysis which used the2011per capita GDP35000yuan as the threshold standard and Zhibituo therapy for incremental analysis showed that Zhibituo was the better treatment. According to the sensitivity analysis, the change of key parameters in the set range did non affect the model results.
CONCLUSION:
In conclusion, Zhibituo treatment was more economical than simvastatin treatment for hyperlipemia patients.Compared to simvastatin treatment,Zhibituo treatment seemed prolonging the life of hyperlipemia patients.This study could be used as methodology reference of pharmacoeconomics on the hyperlipemia diseases for Chinese pharmacoeconomist.The baseline data about transition probability based on foreign research.So the findings of this study should be re-evaluated as soon as additional evidence becomes available from the clinical and economic studies.
引文
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[6]Applied Pharmacoeconomics and Outcomes Research Forum-Fall 2008论坛
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