达沙替尼治疗伊马替尼耐药的慢性粒细胞白血病的药物经济学评价

发布时间：2018-05-06 21:37

本文选题：达沙替尼 + 慢性粒细胞白血病　；参考：《中国药房》2015年02期

【摘要】：目的:综合考虑达沙替尼和大剂量伊马替尼在治疗伊马替尼耐药的慢性粒细胞白血病(CML)慢性期患者时的健康产出、不良反应及治疗成本,分析哪种用药方案更具经济性,为医保谈判和临床药物遴选提供决策依据。方法:通过文献研究法、专家咨询法获得相关药物临床试验及不良反应信息,结合国内相关药物及不良反应治疗成本,利用Treeage软件构建Markov模型并通过队列分析法和Monte Carlo模拟分别计算两种方案靶向治疗CML5、10、20、30年的疾病转归、健康产出及成本消耗,通过成本-效用分析对伊马替尼产生耐药的CML患者的两种用药方案进行药物经济学评价。结果:贴现率设定为3%且假定患者连续用药30年时,队列分析法与Monte Carlo模拟计算出达沙替尼组的成本-效用比分别为38 881.74元/质量调整生存月(QALM)、40 096.06元/QALM;大剂量伊马替尼组成本-效用比分别为53 844.15元/QALM、55 500.70元/QALM,且无论模拟时间和贴现率如何变化,达沙替尼均为优势药物。敏感度分析结果显示,达沙替尼更具经济性优势。结论:对伊马替尼耐药的CML慢性期患者改用达沙替尼比加大伊马替尼剂量进行治疗更具有较好的经济性。
[Abstract]:Objective: to evaluate the health outcomes, adverse reactions and treatment costs of dasatinib and high dose imatinib in the treatment of chronic myeloid leukemia (CML) patients with imatinib resistance, and to analyze which regimen is more economical. To provide decision basis for medical insurance negotiation and clinical drug selection. Methods: the information of clinical trials and adverse reactions of related drugs were obtained by literature research and expert consultation, combined with the cost of treatment of related drugs and adverse reactions in China. The Markov model was constructed by Treeage software, and the disease outcome, health output and cost consumption were calculated by cohort analysis and Monte Carlo simulation. Cost-utility analysis was used to evaluate the pharmacoeconomics of two drug regimens in patients with CML who were resistant to imatinib. Results: the discount rate was set to 3% and the patients were assumed to be treated continuously for 30 years. Cohort analysis and Monte Carlo simulation calculated the cost-utility ratio of Dasatinib group was 38 881.74 yuan / QALM / QALM40 096.06 yuan / QALM, respectively, and the Cost-Utility ratio of large dose imatinib group was 53 844.15 yuan / QALM5 / QALM55 / 500.70 yuan / QALM, respectively. How the simulation time and discount rate change, Dasatinib is the dominant drug. Sensitivity analysis showed that dasatinib had more economic advantages. Conclusion: it is more economical to use dassatinib than to increase the dose of imatinib in CML patients who are resistant to imatinib.
【作者单位】：暨南大学医学院医学统计学教研室;
【基金】：广州市医药卫生科技重大项目(No.20121A031004)
【分类号】：R733.72;R956

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