地舒单抗和唑来膦酸预防多发性骨髓瘤患者骨骼相关事件的药物经济学评价

Pharmacoeconomic evaluation of denosumab and zoledronic acid for the prevention of skeletal-related events in patients with multiple myeloma

关键词:  【关键词】地舒单抗  唑来膦酸  多发性骨髓瘤骨病  药物经济学评价

Key words:  denosumab  zoledronic acid  multiple myeloma bone disease  pharmacoeconomic evaluation.

摘要:

【】 目的:分析地舒单抗与唑来膦酸预防多发性骨髓瘤患者骨骼相关事件的成本与效用,以期为临床优化用药方案提供依据。方法:从支付者角度出发,使用动态Markov模型模型评价地舒单抗和唑来膦酸方案的成本与效用,得到得到患者的终身成本和质量调整生命年(QALYs),应用III期临床研究NCT01345019的试验数据,相关成本来自我国国内文献资料,对成本-效用分析结果进行单因素敏感性分析和概率敏感性分析。结果:地舒单抗组花费21638.1819元获得14.7004个QALY,唑来膦酸组花费9573.0658元获得14.6315个QALY,其增量成本-效用比为175263.7424元/QALY,当意愿支付阈值取我国3倍人均国内生产总值(GDP)268074元/QALY,地舒单抗组具有成本-效用的概率为93.4％。地舒单抗药物成本用是最敏感的模型参数。结论:在我国患者预防多发性骨髓瘤骨骼相关事件,地舒单抗比唑来膦酸更具成本效用优势。

Abstract:

【】 Objective: To analyse the cost and utility of denosumab versus zoledronic acid for the prevention of skeletal-related events in patients with multiple myeloma with a view to optimising clinical dosing regimens. Methods: The study was conducted from the perspectives of our national healthcare system and patients, and the cost and utility of the denosumab and zoledronic acid regimens were evaluated using a dynamic Markov model to obtain lifetime costs and quality-adjusted life-years (QALYs) for patients, applying data from the phase III clinical study NCT01345019, with the relevant costs derived from the published literature in China, and conducting a one-way sensitivity analysis of the results of the cost-utility analyses. The results of the cost-utility analysis were subjected to one-way sensitivity analysis and probabilistic sensitivity analysis. Results: The incremental cost-utility ratio was 175263.7424 Yuan/QALY for the desutumumab group, which cost 21638.1819 Yuan to obtain 14.7004 QALYs, and 9573.0658 Yuan for the zoledronic acid group, when the willingness-to-pay threshold was taken to be 3 times China"s Gross Domestic Product (GDP) of 268074 Yuan/QALY, and the incremental cost-utility ratio was 175263.7424 Yuan/QALY for the zoledronic acid group, which was 175263.7424 Yuan/QALY. QALY, the probability of having cost-utility in the denosumab group was 93.4%. The cost-utility of denosumab drug was the most sensitive model parameter. Conclusion: denosumab has a cost-utility advantage over zoledronic acid for the prevention of skeletal-related events in multiple myeloma in our patients.