中国成本环境下茚达特罗与噻托溴铵治疗COPD的成本效果分析

摘要

Objective: This study evaluated the cost-effectiveness of Indacaterol (150 ug) versus Tiotropium applied to the patients with Chronic obstructive pulmonary disease (COPD) in Guangzhou and Beijing, China.Methods: Markov model was developed to simulate the progress of COPD for 3 years and whole life respectively. The transfer probability in the Markov model and the utility of different Markov status were from the Indacaterol 's clinical trial conducted in the US. Medical cost data of Chinese COPD patients are extracted from the Guangzhou health insure database. During the simulation, both the costs and utilities are annually depreciated at the rate of 3.5%.Results: Within 3 years, the Indacaterol group cost 20,089 CNY per capita, and gained 2.151 QALY or 2.736 LY per capita; the Tiotropium group cost 23,616 CNY per capita and gained 2.143 QALY or 2.730 LY per capita. Thus, compared with the Tiotropium group, the Indacaterol group saved 3527 CNY and gained more 0.008 QALY or 0.006 LY for every patient within 3 years. In the lifetime simulation, Indacaterol group cost 66150 CNY and gained 8.083 QALY or 10.327 LY per capita, while the Tiotropium group cost 74915 CNY and gained 8.000 QALY or 10.230 LY per capita. Thus, compared with the Tiotropium group, the the Indacaterol group saved 8766 CNY and gained more 0.083 QALY or 0.097 LY per capita in the lifetime.Conclusions: According to the medical costs of COPD patients in Guangzhou and Beijing, China, the cost-effectiveness of Indacaterol is dominant over that of Tiotropium.%目的：在中国医疗成本环境下，比较茚达特罗与噻托溴铵为期三年和终生治疗COPD患者的经济性。方法：通过建立马尔科夫模型模拟COPD的进展状态，不同疾病状态的转化概率来源国外茚达特罗的临床试验数据，医疗成本数据来源于北京很和广州的COPD参保患者医保数据分析结果。结果：在北京，为期三年的治疗中，茚达特罗组人均治疗成本为20744.06元，共获得2.151Q A LY和2.736LY；噻托溴铵组为人均治疗成本为24300.75元，共获得2.143QALY和2.730LY；茚达特罗与噻托溴铵相比，共节约医疗成本3556.69元，增加0.008QALY和0.006LY。为期终生的治疗中，茚达特罗组人均治疗成本为66149.96元，共获得8.083QALY和10.327LY；噻托溴铵组为人均治疗成本为74915.49元，共获得8.000QALY和10.230LY；茚达特罗与噻托溴铵相比，共节约医疗成本8765.53元，增加0.083年质量生命年和0.097年期望寿命。广州和北京的效果数据来源一致，其主要差别体现在成本上，在广州，为期三年的治疗中，茚达特罗比噻托溴铵节约医疗成本3526.58元；在为期终生的治疗中，茚达特罗比噻托溴铵节约医疗成本8719.02元。结论：与噻托溴铵相比，茚达特罗(150μg)治疗COPD成本较更低，效果更好，是成本节约的方案，更具有经济性。