阿仑膦酸钠预防绝经后妇女骨质疏松性骨折的成本-效用分析
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篇名: 阿仑膦酸钠预防绝经后妇女骨质疏松性骨折的成本-效用分析
TITLE:
摘要: 目的:评价阿仑膦酸钠预防绝经后妇女骨质疏松性骨折的经济性,为骨质疏松及骨量低下患者选择经济、有效的药物治疗方案提供参考。方法:选择Markov经济学模型,以基础用药(钙剂与维生素D3)和基础用药联合阿仑膦酸钠的随机对照试验文献数据作为基线数据,使用TreeAge Pro 2011软件进行成本-效用分析。以质量调整生命年(QALY)及增量成本效用比(ICUR)作为经济学评价指标,通过单因素敏感度分析考察所建模型的稳定性。结果:基础用药组的QALY为0.704年,联合用药组的QALY为0.708年,两组间的ICUR为714 252.44。对于髋部骨折后期和发生其他骨折的人群,联合用药组均是高成本、低收益,明显不具有经济学优势;但是对于发生椎体骨折的人群,联合用药组发生骨折的累计概率明显低于基础用药组,两组间的ICUR仅为13 902.17,显示出经济学优势;对于发生髋部骨折的人群,基础用药组和联合用药组发生骨折的累计概率相同,两组间的ICUR为19 109.00,显示出经济学优势;对于发生腕部骨折的人群而言,疗效与经济性有待进一步探讨。结论:对于骨质疏松性骨折的低风险人群使用钙剂和维生素D3来预防骨折更为经济;而对于易发生椎体和髋部骨折的高风险人群,选择阿仑膦酸钠联合基础用药则兼顾了有效性与经济性。
ABSTRACT: OBJECTIVE: To evaluate the economics of alendronate sodium preventing osteoporotic fractures in postmenopausal women, and to provide reference for osteoporotic and osteopenia patients to select economical and effective therapy plan. METHODS: Using Markov economic model, TreeAge Pro 2011 software was used for cost-utility analysis using RCTs literature data of basic medication (calcium and vitamin D3) and basic medication combined with alendronate sodium as baseline data. Using quality adjusted life years (QALYs) and incremental cost utility ratio (ICUR) as economics evaluation indexes, the stability of established model was investigate by single factor sensitivity analysis. RESULTS: QALYs of the basic treatment group was 0.704 years, and QALYs of drug combination group was only 0.708 years. However, ICUR of two groups reached 714 252.44.  For the late period of hip fracture and other fractures, drug combination group was in high cost and low benefit, obviously had no economic advantage. For vertebral fractures, the cumulative probability of fracture in drug combination group was significantly lower than basic treatment group, and ICUR of the two groups was only 13 902.17, with economic advantage. For hip fracture, the cumulative probability of fracture in basic treatment group was the same as drug combination group, and ICUR was 19 109.00, with economic advantage. For wrist fractures, curative effect and economy needed further study. CONCLUSIONS: For the low-risk population with osteoporotic fractures, calcium and vitamin D3 are more economical in preventing osteoporosis fractures. For the high-risk population with vertebral and hip fractures, alendronate sodium combined with basic treatment is effective and economical.
期刊: 2017年第28卷第17期
作者: 冯鑫,高颖,潘雪梅,毛佳佳,房德敏
AUTHORS: FENG Xin,GAO Ying,PAN Xuemei,MAO Jiajia,FANG Demin
关键字: 阿仑膦酸钠;骨质疏松;骨质疏松性骨折;成本-效用分析;药物经济学
KEYWORDS: Alendronate sodium; Osteoporosis; Osteoporotic fractures; Cost-utility analysis; Pharmacoeconomics
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