灯盏生脉胶囊用于缺血性脑卒中二级预防的成本效用分析

目的:对于中国缺血性脑卒中患者,分析使用灯盏生脉胶囊联合标准二级预防方案或单用标准预防方案进行二级预防的成本效用。方法:基于全社会视角,构建Markov模型,模拟患者5年的成本和质量调整生命年。模型包括4个健康状态,分别是未复发卒中、复发卒中不依赖他人照料(mRS0-2)、复发卒中依赖他人照料(mRS3-5)和死亡。临床数据和健康效用值来自公开发表的文献;直接医疗费用包括住院费、出院后康复费及二级预防费,数据来源于公开发表的文献,并使用医疗服务价格指数调整到2019年;药品成本来自公开的数据库;间接成本考虑残障患者家庭照料产生的误工成本,数据来自统计年鉴。结果:基础分析结果显示,灯盏生脉胶囊组和对照组5年累积成本分别为29 284和21 551元,累积效果分别为3.91和3.81 QALYs。灯盏组与对照组相比的增量成本为7 734元,增量效果为0.1 QALYs,增量成本效果比为74 479元,约为1.05倍人均GDP,小于3倍人均GDP的阈值,灯盏生脉胶囊联合标准二级预防方案更具有经济性;敏感性分析显示了该研究结果的稳健性。结论:相比单独使用标准二级预防方案,缺血性卒中患者联合使用灯盏生脉胶囊进行二级预防是一种更具经济学优势的方案。

Cost-utility analysis of Dengzhan Shengmai capsule for secondary stroke prevention

Objective: This study aims to analyze the cost-utility of the add-on of Dengzhan Shengmai( DZSM) capsule with standard medical therapy and standard medical therapy alone in secondary stroke prevention.Methods: A Markov model was constructed based on the societal perspective and the costs and health unities were simulated for a time horizon of 5 years. The model included 4 health states,included healthy,recurrent strokeindependent( mRS0-2),recurrent stroke-dependent( mRS3-5) and death. Clinical data and utilities for the modelling analysis were obtained from published literatures. Direct costs included medication costs obtained from public database,and costs for hospitalization,post-discharge rehabilitation service,and secondary prevention were sourced from published literatures. 2019 inflation-adjusted costs were calculated using Consumer Price Index( CPI) for medical care. Indirect costs included loss of salary for patients and their families caused by the disease which were derived from China statistical yearbook. Results: Base-case analysis results showed that the incremental costs of DZSM group( 29 284 RMB) over 5 years were higher than the control group( 21 551 RMB). The incremental health utilities of DZSM group( 3. 91 QALYs) over 5 years were also greater than the control group( 3. 81 QALYs).The incremental costs of the two group were 7 734 RMB,while the incremental utilities were 0. 1 QALYs. The incremental cost-utility ratio was 74 479 RMB/QALY,which equals to approximately 1. 05 times of GDP per capita and less than 3 times of GDP per capita,indicating that the add-on of DZSM capsule with standard medical therapy were more cost-effective. Sensitivity analyses revealed robust results. Conclusion: Compared to standard medical therapy alone,the add-on of DZSM capsule has economic advantages in secondary stroke prevention.