目的 引入Markov模型对厄贝沙坦与比索洛尔治疗高血压伴心衰进行药物经济学研究,评价高血压伴心衰安全有效、具有经济性的用药方案,指导临床合理用药。方法 建立厄贝沙坦与比索洛尔治疗高血压伴心衰的Markov模型,分别对厄贝沙坦与比索洛尔2种药物治疗高血压病患者无事件、非致死性心肌梗死、非致死性卒中和死亡的动态变化进行模拟。运用Markov模型进行回乘分析、队列模拟获得厄贝沙坦与比索洛尔治疗高血压伴心衰的长期效果与成本,同时对成本、效用值进行敏感度分析,找出临床相对较优的治疗药物。结果 Markov模型成本-效果分析显示厄贝沙坦治疗方案的累计成本和健康结果分别为60 635.48元和6.22QALYs(质量调整生命年,Quality Adjusted Life Years),比索洛尔治疗方案的累计成本和健康结果分别为58 185.12元和6.17QALYs,厄贝沙坦治疗相对于比索洛尔治疗的ICER(增量成本效果比,Incremental Cost Effectiveness Ratio)为49 007.20元/QALYs。敏感度分析显示,各参数在设定的范围内变化不影响模型分析结论。结论 厄贝沙坦与比索洛尔治疗组相比,比索洛尔治疗组的成本效果优于厄贝沙坦治疗组,因此应优先选择比索洛尔作为高血压伴心衰患者的治疗药物,从而获得更优的经济学效益,使有限的医疗资源利用最大化。
Abstract
OBJECTIVE To analyze the cost-effectiveness of irbesartan and bisoprolol using Markov model for the purpose of choosing a secure and effective therapy for hypertension with heart failure. METHODS Markov state transition model was built to simulate the dynamic changes of the four states (event free, non-fatal myocardial infarction, non-fatal stoke and death) in the hypertension with heart failure patients who received the irbesartan or bisoprolol treatment. Markov model was applied using roll back analysis, Markov cohort simulation to project the costs and effectiveness for the hypertension with heart failure who had been long-term treated with irbesartan or bisoprolol. One way sensitivity analysis was carried out to determine the robustness of this baseline results. RESULTS The results of cost-effectiveness analysis showed that patients receiving irbesartan cumulative costs and effects were 60 635.48 yuan and 6.22 quality-adjusted life years gained. Patients receiving bisoprolol cumulative costs and effects were 58 185.12 yuan and 6.17 quality-adjusted life years gained and the ICER was 49 007.20 yuan/QALYs. According to the sensitivity analysis, the change of key parameters in the set range did not affect the model results. CONCLUSION Bisoprolol treatment is more economical than irbesartan treatment for hypertension with heart failure patients. This study could be used as methodology reference of pharmacoeconomics on the hypertension with heart failure diseases for Chinese pharmacoeconomist.
关键词
厄贝沙坦 /
比索洛尔 /
Markov模型 /
成本-效果
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Key words
irbesartan /
bisoprolol /
Markov model /
cost-effectiveness
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中图分类号：
R956
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参考文献
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