从不确定性分析视角看成本效果阈值的应用

目的介绍成本效果平面在不确定性分析中的作用,明确成本效果阈值λ对成本效果平面以及不确定性分析中成本效果可接受曲线、成本效果可接受边界等方法的意义。方法从成本效果平面、成本效果可接受曲线、成本效果可接受边界的基本原理出发,分析成本效果阈值在3种方法中的应用。结果与结论成本效果阈值的设定可以决定成本效果平面中经济性区域的联合密度分布,提高成本效果可接受曲线、成本效果可接受边界等不确定性分析方法的实用性,从而可以更好的为决策制定提供服务。     

对我国成本效果阈值确定方法的思考

目的:对成本效果阈值现有的主要确定方法进行分析,寻找适合我国的阈值确定方法,为我国成本效果阈值的确定及应用奠定基础。方法:通过文献综述的方法,对目前主要的成本效果阈值确定方法进行回顾分析和归纳总结,在此基础上找出适合我国的成本效果阈值确定方法。结果:社会意愿支付法、阈值寻找者模式、人均GDP法均对我国成本效果阈值的确定有重要的借鉴意义。结论:建议以阈值寻找者模式为主、以人均GDP法(社会意愿支付法)为参考来确定我国的成本效果阈值,在寻找我国的成本效果阈值期间,可暂时先借鉴人均GDP法确定的经济性评价标准。     

影响贴现率选择的关键要素:成本效果阈值

目的:明确成本效果阈值是成本与效果贴现率选择的关键性影响因素,为进一步完善我国的贴现率提供启示。方法:通过介绍贴现率计算的公式推导来分析成本效果阈值如何影响贴现率的选择。结果:当两个时期的成本效果阈值相同时,成本和效果应该使用相同的贴现率;当两个时期的成本效果阈值不同时,应对成本和效果分别选择不同的贴现率进行计算。结论:成本效果阈值是影响成本贴现率与结果贴现率是否同一的关键性因素。     

成本效果阈值确定方法分类研究进展(英文)

成本效果分析在卫生保健领域的决策制定当中所起的作用越来越重要。成本效果阈值是成本效果分析的重要决策标准。本文将对成本效果阈值的定义进行回顾,并对现有的成本效果阈值确定方法进行分类介绍,同时对这些现有方法各自的优缺点进行比较分析。在预算具有相对灵活性,即易于改变(增加)既定预算的情况下,成本效果阈值的确定方法主要包括:从过去的决策当中推测阈值、将特殊卫生保健项目的ICER值作为成本效果阈值或借鉴其他公共领域中生命/健康的价值、社会意愿支付法、借助人均GDP确定成本效果阈值法、以及经验确定法。在难以改变既定预算限制的情况下,即当预算具有相对固定性时,能够用于确定成本效果阈值的方法包括:影子价格法、机会成本法和阈值寻找者模型法。现有的八种方法具有其各自的优缺点和适用条件,本文对这些现有方法进行介绍和比较分析,以期能够为我国的成本效果阈值确定方法的选择提供信息储备和支持。     

成本-效果可支付曲线的理论与应用

目的:从理论和应用角度对一种新兴分析工具——成本-效果可支付曲线进行介绍,以期为我国药品决策研究与实践提供新思路。方法:通过分析成本-效果平面中成本-效果阈值线和可支付线的含义来引出和分析成本-效果可支付曲线,并借助已有实证研究对其含义进行分析和解释。结果:成本-效果可支付曲线结合了可支付线与阈值线二者提供的信息,是成本-效果阈值和预算限制的函数。结论:成本-效果可支付曲线可同时提供经济性与可支付性信息,在给定预算下随成本-效果阈值的变化而变化。     

社会意愿支付法确定成本效果阈值的介绍与思考

目的:介绍并分析社会意愿支付法的基本理论,为我国成本效果阈值的确定提供一定的方法论基础。方法:总结社会意愿支付法的优缺点,并与我国实际情况相结合,明确其对我国成本效果阈值确定的借鉴意义。结果:社会意愿支付法有体现民众意愿、随经济发展水平变化等优点、同时在理论角度、实践角度、制度角度以及方法本身角度等方面均存在一定的争议。结论:社会意愿支付法是最常用的成本效果阈值确定方法之一,在理论与实践等方面均有着独特的优势,运用该方法将会对我国的成本效果阈值科学确定起到积极的推进作用。     

我国药物经济学成本-效果阈值测算方法的选择与数据获取方法研究

目的：为我国药物经济学成本-效果阈值测算方法的选择和数据获取方法提供借鉴经验,以期我国在医保准入中设定合适的阈值参考范围,将真正具有经济性的药物纳入医保目录。方法：通过搜集整理现有成本-效果阈值测算方法的优劣势,结合国内外医保基金预算的灵活程度、数据获取的途径、 类型和测算方法的选择,试图寻找适合我国的阈值测算方法和数据获取方法。结果：我国的医保基金预算的灵活度不高且具有医保控费的压力,适宜选择机会成本法,但该方法数据获取难度较大,为提高该方法测算结果的可靠性,英国还通过ICD-10代码对疾病进行分类获取数据,在当前数据获取难度较大的情况下,有操作性较强的意愿支付法或人均国内生产总值（Gross Domestic Product,GDP）法可供选择。结论：我国适宜选择机会成本法,在当前数据获取难度较大的情况下,建议选择意愿支付法或人均 GDP法测得阈值作为参考。     

成本效果可接受曲线与成本效果阈值

成本效果可接受曲线是药物经济学评价不确定性分析中的重要工具。成本效果阈值是药物经济学评价不可缺少的结果比照标准。二者之间有一定关联,但成本效果可接受曲线不能代替成本效果阈值,成本效果阈值的存在可以使成本效果可接受曲线的分析结果更加科学准确。     

信息价值分析与成本效果阈值

本文介绍了信息价值分析,明确信息价值分析与成本效果阈值之间的关系,指出在我国医药领域引进信息价值分析的必要性,从而进一步论证确定成本效果阈值的理论与现实意义。本文另阐述了信息价值分析的含义、指标及方法,深入分析并举例说明其与成本效果阈值的关系。信息价值分析可视为对不确定性分析的深化,能够定量计算降低不确定性所带来的期望价值;成本效果阈值对信息价值分析意义重大,其取值对信息价值分析起着决定性作用。引进信息价值分析有助于提高行业整体效率。     

从净收益视角探讨成本-效果阈值的意义

目的:旨在从净收益法视角出发,明确成本-效果阈值在药物经济学中的重要意义。方法:分类介绍净收益法的4种情况,从理论方法层面分析4种情况下成本-效果阈值与净收益法的内在联系。结果:净收益法4种情况中的任何一种都要受到成本-效果阈值的影响。结论:净收益法的4种情况均是成本-效果阈值的函数,成本-效果阈值的取值直接决定净收益计算结果。     

Cost-effectiveness of Ribociclib in HER2- negative breast cancer: A synthesis of current evidence

BackgroundThe main aim of this study was to investigate the cost-effectiveness of Ribociclib in the treatment of patients with breast cancer by assessing the published evidence.MethodA systematic review of the published literature was conducted to identify the economic evaluations/cost-effectiveness study of Ribociclib. In this study, several databases were inspected, including PubMed, NHS Economic Evaluation, Cochran, and Scopus. Studies were eligible if they assessed the cost-effectiveness of Ribociclib and reported incremental cost-effectiveness ratio (ICER). The study was performed and conducted following the PRISMA reporting guidelines.ResultsOf 70 studies identified, 8 articles meet our inclusion criteria. The cost-effectiveness threshold varied from $24,144.18 in Spain to $198,000/QALY in the USA. Moreover, the result demonstrated that the mean ICER varied across different countries $1,863.47/QALY in Spain and $813,132/QALY in the USA.ConclusionAmong all CDK4/6 inhibitors medications, current evidence indicated that the use of Ribociclib for HER2- negative breast cancer management was beneficial and considered to be cost-effective. Future research is needed to investigate the role of Ribociclib in long-term treatment.     

晚期肝癌治疗药物的经济学文献研究

目的探讨晚期肝癌治疗药物的成本-效果,为临床合理用药提供参考。方法检索国内外关于治疗晚期肝癌的药物经济学文献,分析研究设计、模型建立及参数设置。结果共纳入文献18篇,大多数研究根据Ⅲ期临床试验的数据建立Markov模型,比较治疗方案间的增量-成本比和患者支付意愿阈值;多数研究结果显示,索拉非尼不具有成本-效果,肝癌二线治疗药物瑞戈非尼、卡博替尼、雷莫芦单抗也不具有成本-效果。结论研究结果受国家、人群的影响,但多数研究显示,晚期肝癌靶向治疗药物不具有成本-效果,可在我国开展真实世界的药物经济学评价进一步论证。     

Pharmacoeconomics of influenza vaccination in the elderly: reviewing the available evidence

Most western countries have influenza vaccination programmes for citizens aged > or = 65 years. This paper reviews the available evidence on whether elderly influenza vaccination is worthwhile from a pharmacoeconomic point of view. A search on Medline and EMBASE resulted in a primary selection of approximately 100 studies on the pharmacoeconomics of influenza vaccination in the elderly. Further selection of studies to be included in the review was based on several criteria such as original research paper, cost-benefit or cost-effectiveness analysis. influenza vaccination in the elderly, and publication between 1980 and 1999. The 10 studies included in the final selection were evaluated regarding 3 main aspects: benefit-cost ratio and cost-effectiveness ratio; vaccine effectiveness; and relative costing of the vaccine. In general, differences in benefit-cost ratios could be explained by differences in effectiveness and relative costing of the vaccine. Considering the available pharmacoeconomic evidence, influenza vaccination of the elderly in western countries is an intervention with favourable cost-effectiveness in terms of net costs per life-year gained and even has cost-saving potential. In particular, influenza vaccination among elderly people at higher risk, such as the chronically ill elderly, is generally found to be cost saving. Relatively favourable cost-effectiveness among non-high-risk elderly justifies universal influenza vaccination of the elderly from a pharmacoeconomic point of view.     

Rotavirus vaccine RIX4414 (Rotarix™): a pharmacoeconomic review of its use in the prevention of rotavirus gastroenteritis in developing countries

This article provides an overview of the clinical profile of rotavirus vaccine RIX4414 (Rotarix?) in the prevention of rotavirus gastroenteritis (RVGE) in developing countries, followed by a comprehensive review of pharmacoeconomic analyses with the vaccine in low- and middle-income countries. RVGE is associated with significant morbidity and mortality among children <5 years of age in developing countries. The protective efficacy of a two-dose oral series of rotavirus vaccine RIX4414 has been demonstrated in several well designed clinical trials conducted in developing countries, and the 'real-world' effectiveness of the vaccine has also been shown in naturalistic and case-control trials after the introduction of universal vaccination programmes with RIX4414 in Latin American countries. The WHO recommends universal rotavirus vaccination programmes for all countries. Numerous modelled cost-effectiveness analyses have been conducted with rotavirus vaccine RIX4414 across a wide range of low- and middle-income countries. Although data sources and assumptions varied across studies, results of the analyses consistently showed that the introduction of the vaccine as part of a national vaccination programme would be very (or highly) cost effective compared with no rotavirus vaccination programme, according to widely used cost-effectiveness thresholds for developing countries. Vaccine price was not known at the time the analyses were conducted and had to be estimated. In sensitivity analyses, rotavirus vaccine RIX4414 generally remained cost effective at the highest of a range of possible vaccine prices considered. Despite these favourable results, decisions regarding the implementation of universal vaccination programmes with RIX4414 may also be contingent on budgetary and other factors, underscoring the importance of subsidized vaccination programmes for poor countries through the GAVI Alliance (formerly the Global Alliance for Vaccines and Immunization).     

The value of clopidogrel versus aspirin in reducing atherothrombotic events: the CAPRIE study

Atherothrombotic disease is a growing health problem, and is increasingly more costly to manage. Clopidogrel is an advanced, specific adenosine diphosphate receptor antagonist, which has been shown to be a highly potent antiplatelet agent. Data from the Clopidogrel versus Aspirin in Patients at Risk of Ischaemic Events (CAPRIE) study have demonstrated the significantly superior clinical benefit of clopidogrel over aspirin for secondary prevention of atherothrombotic disease, with a relative risk reduction in myocardial infarction, stroke or vascular death of 8.7% (95% confidence interval 0.3, 16.5; P = 0.043). Moreover, clopidogrel demonstrated an amplified clinical benefit versus aspirin in patients at high risk of atherothrombotic events, such as those with a previous history of symptomatic atherothrombotic disease or with major risk factors such as diabetes mellitus or hypercholesterolaemia. On the basis of commonly accepted threshold criteria (Euros 20000 per life-year gained; LYG), clopidogrel in comparison with aspirin is cost-effective for the secondary prevention of atherothrombotic disease (cost per LYG ranging from Euros 19462 to Euros 3256). Economic analyses have demonstrated consistent cost-effectiveness results with clopidogrel in different countries. Moreover, in high-risk patient subgroups the cost-effectiveness of clopidogrel in comparison with aspirin was evenbetter (cost per LYG ranging from Euros 5900 to Euros 6310). Compared with other treatment strategies used for the prevention of ischaemic or atherothrombotic events, the cost-effectiveness of clopidogrel in comparison with aspirin based on CAPRIE is favourable, with most analyses in the intermediate range of cost-effectiveness. The available data thus support the use of clopidogrel as a clinically efficient and cost-effective option for secondary prevention of atherothrombotic disease, particularly in high-risk patients.