基于Markov模型的肺动脉高压靶向治疗药物的成本-效果分析

目的：评价中国医疗环境下肺动脉高压一线靶向治疗药物的成本-效果。方法：从支付者角度，根据肺动脉高压的自然转归和现有的医疗成本构建Markov模型。结果指标包括人均总成本、总质量调整生命年和增量成本-效果比，应用一元敏感度和概率敏感度分析验证模型稳定性。结果：基线分析结果显示：在整个生命周期的模拟过程中安立生坦、马昔腾坦、波生坦、他达拉非、西地那非和姑息治疗的人均医疗成本分别为363 406.14，481 387.69，323 264.71，167 531.23，41 700.08和24 507.12元，人均可获得5.61，6.14，5.23，5.88，4.64和2.33个质量调整生命年，姑息治疗作为对照组的增量成本-效果比分别为103 410.74，120 034.97，103 079.80，40 351.36和7 438.14元/质量调整生命年，小于预设的意愿支付阈值，敏感度分析显示结果稳定。结论：在中国肺动脉高压患者使用安立生坦、马昔腾坦、波生坦、他达拉非和西地那非具有成本-效果性。

Cost-effectiveness of targeted therapy drugs for pulmonary arterial hypertension: a Markov model analysis

OBJECTIVE To evaluate the cost-effectiveness of targeted therapies for patients with pulmonary arterial hypertension in China's medical environment.METHODS Form the payer's perspective, a Markov model was built based on the nature history of pulmonary arterial hypertension and the current medical cost. The result indicators included per capita medical cost,per capita quality adjusted life year gained and incremental cost-effectiveness ratio (ICER). One-way sensitivity analysis and probability sensitivity analysis were performed to assess the stability of the model.RESULTS The baseline analysis showed that in the life-time simulated treatment, the per capita medical costs for ambrisentan, macitentan, bosentan, tadalafil, sildenafil and alleviative treatment were 363 406.14, 481 387.69, 323 264.71, 167 531.23, 41 700.08 and 24 507.12 yuan,and they could obtain 5.61, 6.14, 5.23, 5.88, 4.64 and 2.33 QALYs, respectively. The corresponding ICERs respectively were 103 410.74, 120 034.97, 103 079.80, 40 351.36 and 7 438.14 yuan/QALY, when alleviative treatment was used as the control, which were less than the preset willingness to pay threshold. The sensitivity analysis showed that the results were stable.CONCLUSION The results show that ambrisentan, macitentan, bosentan, tadalafil and sildenafil might be cost-effectiveness options in pulmonary arterial hypertension in China.