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    利妥昔单抗对比环磷酰胺/硫唑嘌呤治疗抗中性粒细胞胞浆抗体相关性血管炎的成本-效果分析

    Cost-effectiveness Analysis of Rituximab and Cyclophosphamide/Azathioprine in the Treatment of Antineutrophil Cytoplasmic Antibody-associated Vasculitis

      摘要
    • 摘要:
      目的 从中国卫生体系角度评价利妥昔单抗(rituximab，RTX)对比环磷酰胺(cyclophosphamide，CYC)/硫唑嘌呤(azathioprine，AZA)治疗抗中性粒细胞胞浆抗体相关性血管炎antineutrophil cytoplasmic antibody(ANCA)-associated vasculitis，AAV的经济性。
      方法 基于2项随机对照试验(randomised controlled trials，RCT)研究结果，建立马尔可夫模型进行成本-效果分析，循环周期为6个月，模拟时限为患者终身，贴现率为5%。以增量成本-效果比(incremental cost-effectiveness ratio，ICER)为指标评价经济性，并对结果进行敏感性分析。
      结果 成本-效果分析结果显示，RTX对比CYC/AZA的ICER为美元/质量调整生命年，低于2022年中国3倍人均国内生产总值(gross domestic product，GDP)。单因素敏感性分析结果显示，对ICER影响最大的是RTX的价格、贴现率、疾病活动状态效用值；概率敏感性分析显示，当意愿支付(willingness-to-pay，WTP)阈值为3倍GDP时，RTX对于CYC/AZA具有成本-效果。
      结论 在诱导及维持治疗AAV方面，RTX较CYC/AZA更具成本-效果性。

       

      Abstract:
      OBJECTIVE  To evaluate the economics of rituximab(RTX) versus cyclophosphamide(CYC)/azathioprine(AZA) for the treatment of antineutrophil cytoplasmic antibody(ANCA)-associated vasculitis(AAV) from the Chinese healthcare system.
      METHODS Based on the results of two randomised controlled trials(RCT), a Markov model was developed for cost-effectiveness analysis, with a cycle of 6 months, a simulation timeframe of patients’ lifetime, and a discount rate of 5%. The incremental cost-effectiveness ratio(ICER) was used as an indicator to evaluate the economics, and the results were analyzed for sensitivity.
      RESULTS The results of the cost-effectiveness analysis showed that the ICER of RTX versus CYC/AZA was USD/quality-adjusted life year, which was lower than 3 times the per capita gross domestic product(GDP) of China in 2022. The results of the one-factor sensitivity analysis showed that the most influential factors on the ICER were the price of RTX, discount rate, and utility value of the disease activity status; and the probabilistic sensitivity analysis showed that RTX was cost-effectiveness compared to CYC/AZA, when the willingness-to-pay threshold was set at 3 times the GDP, the RTX had a cost-effectiveness for CYC/AZA.
      Conclusion In induction and maintenance treatment of AAV, compared with CYC/AZA, RTX is more cost-effectiveness.

       

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