氨氯地平和赖诺普利治疗老年高血压的经济学评价——基于Markov模型
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摘要
目的:对氨氯地平和赖诺普利治疗老年高血压进行经济学研究,评价老年高血压用药的安全有效性和经济性。方法:构建氨氯地平和赖诺普利治疗老年高血压Markov模型,动态模拟疾病发展;对模型进行回乘分析、队列分析,获取两种药物治疗老年高血压的成本和效果,并进行敏感性分析,查看结果的稳定性。结果:氨氯地平治疗方案累积成本和健康效用分别为63 372.61元和13.5QALYs,赖诺普利治疗方案的累积成本和健康效用分别为68788.68元和13.44QALYs,氨氯地平更具成本效果;敏感性分析显示,各参数在设定的范围内变化不影响模型结果。结论:对老年高血压患者来说,选择氨氯地平更具成本效果。
Objective To conduct an economic study on the treatment of senile hypertension with amlodipine and lisinopril,and to evaluate the safety,efficacy and economy of senile hypertension medication. Methods Amlodipine and lisinopril were used to treat the senile hypertension Markov model,and to simulate disease development dynamically. The model was analyzed by back-multiplication analysis and cohort analysis to obtain the cost and effect of two drugs for the treatment of senile hypertension,and the sensitivity analysis was performed to check the stability of the results. Results The cumulative cost and health effects of amlodipine treatment were 63 372.61 yuan and 13.5 QALYs,respectively. The cumulative cost and health effects of lisinopril treatment were 68 788.68 yuan and 13.44 QALYs,respectively. Amlodipine was more cost effective.Sensitivity analysis showed that changes in the parameters within the set range did not affect the model results. Conclusion Amlodipine is more cost effective for senile hypertensive patients.
Objective To conduct an economic study on the treatment of senile hypertension with amlodipine and lisinopril,and to evaluate the safety,efficacy and economy of senile hypertension medication. Methods Amlodipine and lisinopril were used to treat the senile hypertension Markov model,and to simulate disease development dynamically. The model was analyzed by back-multiplication analysis and cohort analysis to obtain the cost and effect of two drugs for the treatment of senile hypertension,and the sensitivity analysis was performed to check the stability of the results. Results The cumulative cost and health effects of amlodipine treatment were 63 372.61 yuan and 13.5 QALYs,respectively. The cumulative cost and health effects of lisinopril treatment were 68 788.68 yuan and 13.44 QALYs,respectively. Amlodipine was more cost effective.Sensitivity analysis showed that changes in the parameters within the set range did not affect the model results. Conclusion Amlodipine is more cost effective for senile hypertensive patients.
引文
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[2]郑刚.老年高血压的临床研究新进展[J].世界临床药物,2018,39(6):369-373.
[3]詹秀娥,乔彩萍.赖诺普利与氨氯地平对老年性高血压患者左心室质量及舒张功能影响的Meta分析[J].内科,2014,9(3):270-274,291.
[4]冯芮华,王增武,王小万.社区常用抗高血压单片复方制剂的经济可负担性研究[J].卫生经济研究,2014(10):91-93.
[5]赖谋锋,盛向远,左慧俐.氨氯地平的药理分析及临床应用研究[J].临床合理用药杂志,2016,9(27):23-25.
[6]崔岩.132383张门诊高血压处方用药分析[J].中国当代医药,2018,25(19):170-172,180.
[7]徐恩平.氨氯地平与赖诺普利治疗老年高血压病的临床观察[J].交通医学,2001(2):157-158.
[8]赵喆.赖诺普利的药理特性和临床应用[J].天津药学,1999(1):10-11.
[9]王艳春,吕巧莉,孙建勋.我国2011-2015年降压药药物经济学研究文献系统评价[J].中国药事,2016,30(7):646-654.
[10]王海兵,余正.原发性高血压药物经济学研究系统评价[J].现代商贸工业,2016,37(10):97-98.
[11]ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group.Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker versus diuretic.JAMA,2002,288:2981.
[12]唐琪.减重手术治疗2型糖尿病临床疗效评价与成本效果评估[D].山东大学,2017.
[13]Tang CH,Chuang PY,Chen CA,Fang YC.Medical costs of cardiovascular diseases in Taiwan.Value Health,2014,17:A759.
[14]Ponagiotis Stafylas,et al.Economic evaluation of a single-pill triple antihypertensive therapy with valsartan,amlodipine,and hydrochlorothiazide against its dual components[J].Cost Effectiveness and Resource Allocation,2015,13:10.
[15]游如旭,刘金玉,张玉,等.应用Markov模型对厄贝沙坦和比索洛尔治疗高血压伴心衰的长期药物经济学评价[J].中国药学杂志,2017,52(24):2209-2213.
[16]花恩桦,刘国恩,孙利华,等.超重与肥胖对高血压患者医疗费用负担的影响[J].卫生经济研究,2017(10):27-29.
[17]桑海强.应用Markov模型对高血压病两种初始联合方案治疗效果的药物经济学评价[D].中南大学,2010.
[18]尹力.急性心肌梗死不同治疗措施疗效及费用效果分析[D].天津医科大学,2002.
[19]张兴文.1.缺血性脑卒中直接医疗成本及其与预后关系研究2.血浆金属蛋白酶9对动脉粥样斑块相关的脑血管事件的预测研究[D].中国协和医科大学,2008.
[20]Joshua D.Stein,GaryC.Brown,Melissa.Brown,et al.The Quality of Life of Patients With Hypertension[J].The Journal of Clinical Hypertension,2002(3):181-188.
[21]Joel M.Gore,Christopher B.Granger,Maarten L.Simoons,et al.Stroke After Thrombolysis:Mortality and Functional Outcomes in the GUSTO-I Trial[J].Circulation,1995(10):2811-2818.
[22]A meta-analysis of quality-of-life estimates for stroke.Tengs Tammy O,Lin Ting H.Pharmacoeconomics.2003,21(3):191-200.