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地舒单抗和唑来膦酸治疗绝经后骨质疏松症的成本-效用分析
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| 篇名： | 地舒单抗和唑来膦酸治疗绝经后骨质疏松症的成本-效用分析 |
| TITLE： | Cost-utility analysis of denosumab and zoledronic acid in the treatment of postmenopausal osteoporosis |
| 摘要： | 目的 评价地舒单抗和唑来膦酸治疗绝经后骨质疏松症的经济性，为相关决策提供参考。方法从我国卫生体系角度出发，利用Excel2003软件建立Markov模型，采用成本-效用分析法评价地舒单抗和唑来膦酸分别联合碳酸钙D3治疗绝经后骨质疏松症的经济性。药物治疗效果来自网状荟萃分析，成本和健康效用值数据来自已发表的文献或网络等。模型的循环周期为1年，模拟时限为患者终身。采用单因素敏感性分析和概率敏感性分析评价模型参数变化对结果稳健性的影响；并通过情境分析探讨唑来膦酸用药周期更改后的经济性。结果地舒单抗方案的效果优于唑来膦酸方案[12.77质量调整生命年（QALYs）vs.11.98QALYs]，同时其成本也更高（51224.56元vs.49221.67元），增量成本-效果比为2544.14元/QALY。单因素敏感性分析结果显示，唑来膦酸注射液和地舒单抗注射液的成本对结果的影响较大。概率敏感性分析结果显示，使用3倍我国2021年人均国内生产总值（GDP）作为意愿支付阈值时，地舒单抗方案具有经济性的概率为85.4％。情境分析结果表明，当唑来膦酸的用药周期更改后，地舒单抗方案仍是更具经济性的方案。结论在1～3倍我国2021年人均GDP的阈值下，地舒单抗联合碳酸钙D3治疗绝经后骨质疏松症较唑来膦酸联合碳酸钙D3更具经济性。 |
| ABSTRACT： | OBJECTIVE To evaluate the cost-effectiveness of denosumab and zoledronic acid in the treatment of postmenopausal osteoporosis ，and to provide reference for relevant decision-making. METHODS From the perspective of Chinese health system ，Excel 2003 software was used to establish Markov model ，and cost-utility analysis was used to evaluate the cost-effectiveness of denosumab or zoledronic acid combined with calcium carbonate D 3 in the treatment of postmenopausal osteoporosis. Pharmacotherapy effects were obtained from the network Meta-analysis ，and cost and health-utility value data were obtained from the published literature or network ，etc. The model cycle was 1 year，and the simulation time limit was the patient ’s lifetime. One-way sensitivity analysis and probabilistic sensitivity analysis were used to evaluate the impact of model parameter changes on the robustness of the results ；and the cost-effectiveness of changing the medication cycle of zoledronic acid were explored through scenario analysis. RESULTS Denosumab regimen was more effective than zoledronic acid regimen （12.77 QALYs vs. 11.98 QALYs），and its cost was also higher than zoledronic acid regimen （51 224.56 yuan vs. 49 221.67 yuan）， and the incremental cost-effectiveness ratio was 2 544.14 yuan/QALY. One-way sensitivity analysis showed that the cost of Zoledronic acid injection and that of Denosumab injection had great impact on the results. The results of probabilistic sensitivity analysis showed that when using 3 times of per capita gross domestic product （GDP）in China in 2021 as the threshold of willingness to pay ，the probability of Denosumab regimen being cost-effective was 85.4％. The results of the scenario analysis showed that the Denosumab regimen was still more cost-effective when the dosing cycle of zoledronic acid was changed. CONCLUSIONS Under the threshold of 1-3 times of Chinese per capita GDP in 2021，denosumab combined with calcium carbonate D 3 is more cost-effective than zoledronic acid combined with calcium carbonate D 3 in the treatment of postmenopausal osteoporosis. |
| 期刊： | 2022年第33卷第14期 |
| 作者： | 杜桂平，高胜男，齐冉，刘旭婷，刘国强 |
| AUTHORS： | DU Guiping ，GAO Shengnan ，QI Ran，LIU Xuting ，LIU Guoqiang |
| 关键字： | 地舒单抗；唑来膦酸；绝经后骨质疏松症；成本-效用分析 |
| KEYWORDS： | denosumab；zoledronic acid ；postmenopausal |
| 阅读数： | 337 次 |
| 本月下载数： | 13 次 |
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