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布立西坦对比吡仑帕奈用于耐药性局灶性癫痫添加治疗的药物经济学评价
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| 篇名： | 布立西坦对比吡仑帕奈用于耐药性局灶性癫痫添加治疗的药物经济学评价 |
| TITLE： | Pharmacoeconomic evaluation of brivaracetam versus perampanel as add-on therapy for drug-resistant focal epilepsy |
| 摘要： | 目的 从中国卫生体系角度，评估布立西坦（BRV）与吡仑帕奈（PER）作为添加治疗方案用于成人耐药性局灶性癫痫的经济性。方法建立Markov模型，模拟成人耐药性局灶性癫痫疾病的发展进程，设定模拟周期为5个月，研究时限为44年，折现率为4.5％。模型所需的临床数据来源于BRV的Ⅲ期临床试验及PER的事后分析研究，成本数据和效用数据来源于药智网及相关文献，意愿支付（WTP）阈值为2倍中国2025年人均国内生产总值（GDP）[199330元/质量调整生命年（QALY）]，采用成本-效果分析法比较两种方案的经济性；通过单因素敏感性分析、概率敏感性分析确认基础分析结论的稳定性。结果BRV50mg/d作为添加治疗方案相较于PER8mg/d方案的增量成本-效果比（ICER）为44823.08元/QALY，低于本研究的WTP阈值；BRV200mg/d相较于PER12mg/d的ICER为238783.00元/QALY，高于WTP阈值。单因素敏感性分析中，癫痫发作≥53次/年的直接医疗成本和每年无癫痫发作状态的健康效用值分别对上述两个ICER结果的影响较大；概率敏感性分析表明上述结果的稳健性较好。结论对于我国成人耐药性局灶性癫痫添加治疗方案的选择，以2倍我国人均GDP为WTP阈值时，BRV50mg/d相较于PER8mg/d更具成本-效果优势，而BRV200mg/d相较于PER12mg/d不具有成本-效果优势。 |
| ABSTRACT： | OBJECTIVE To evaluate the cost-effectiveness of brivaracetam （BRV） versus perampanel （PER） as add-on therapy for drug-resistant focal epilepsy in adults from the perspective of the Chinese healthcare system.METHODS A Markov model was established to simulate the progression of drug-resistant focal epilepsy in adults， with a simulation cycle of 5 months， a time horizon of 44 years， and a discount rate of 4.5%. Clinical data required for the model were derived from the phase Ⅲ clinical trial of BRV and a post hoc analysis of PER； cost data and utility data were obtained from Yaozh and related literature. The willingness-to-pay （WTP） threshold was set at twice China’s 2025 per capita gross domestic product （GDP） [199 330 yuan per quality-adjusted life year （QALY）]， and a cost-effectiveness analysis was adopted to compare the cost-effectiveness of the regimens. One-way sensitivity analysis and probabilistic sensitivity analysis were performed to confirm the stability of the base-case analysis conclusions.RESULTS The incremental cost-effectiveness ratio （ICER） of BRV 50 mg/d as an add-on therapy versus PER 8 mg/d was 44 823.08 yuan/QALY， which was below the WTP threshold； the ICER of BRV 200 mg/d versus PER 12 mg/d was 238 783.00 yuan/QALY， which was above the WTP threshold. In the one-way sensitivity analysis， the direct medical cost of seizures ≥53 times/year and the health utility value of a seizure-free state per year had a relatively large impact on the two ICER results mentioned above， respectively. Probabilistic sensitivity analysis indicated that the above results were robust.CONCLUSIONS For the selection of add-on therapy for drug-resistant focal epilepsy in adults in China， when twice China’s per capita GDP is used as the WTP threshold， BRV 50 mg/d has a cost-effectiveness advantage over PER 8 mg/d， whereas BRV 200 mg/d not have a cost-effectiveness advantage over PER 12 mg/d. |
| 期刊： | 2026年第37卷第18期 |
| 作者： | 乔佳乐；刘凡绮；唐雨晨；程杰；石妍；齐君；董志强 |
| AUTHORS： | QIAO Jiale，LIU Fanqi，TANG Yuchen，CHENG Jie，SHI Yan，QI Jun，DONG Zhiqiang |
| 关键字： | 布立西坦;吡仑帕奈;耐药性局灶性癫痫;药物经济学评价;马尔可夫模型;成本-效果分析 |
| KEYWORDS： | brivaracetam;perampanel;drug-resistant focal epilepsy;Pharmacoeconomic evaluation;Markov model;Cost-effectiveness analysis |
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