Page 76 - 《中国药房》2020年23期

治疗丙肝的第二代直接抗病毒药物的经济性系统评价 Δ

孟 蕊 ，芮明军 ，马 越 ，金 敏 ，陈平钰 （1.中国药科大学国际医药商学院，南京 211198；2.中国药科
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大学药物经济学评价研究中心，南京 211198）
中图分类号 R956；R978.7 文献标志码 A 文章编号 1001-0408（2020）23-2882-07
DOI 10.6039/j.issn.1001-0408.2020.23.12

摘 要 目的：系统评价治疗丙型病毒性肝炎（简称“丙肝”）的第二代直接抗病毒药物（DAAs）的药物经济学研究，为今后开展此
类研究提供方法学建议，同时为医保目录调整及市场准入提供决策参考。方法：检索 PubMed、Embase、The Cochrane Library、中
国知网、万方数据库和维普数据库，收集治疗丙肝的第二代DAAs的经济学评价研究，检索时限为2015年1月－2020年1月。使
用卫生经济学评价报告标准共识（CHEERS）清单评估纳入研究质量，提取资料汇总并进行定性分析。结果：共纳入14项研究，其
标准符合率在79.2％～95.8％之间，属于较高质量研究。13项（92.9％）研究从付费方角度采用Markov模型及终生研究时限对比
了不同治疗方案的经济性。与基于索磷布韦的第二代DAAs治疗方案比较时，所有研究结果显示，奥比帕利联合达塞布韦、艾尔
巴韦/格拉瑞韦、格卡瑞韦/哌仑他韦这3种方案在目标国家的经济性更好；单因素敏感性分析显示，研究结果对于药品价格、药物
病毒学应答（SVR）率和健康状态效用值3类参数较为敏感。结论：在治疗丙肝的第二代DAAs中，奥比帕利联合达塞布韦、艾尔巴
韦/格拉瑞韦、格卡瑞韦/哌仑他韦这3种方案的药物经济性更好。建议今后的抗丙肝药物经济学研究采用动态模型和全社会的研
究角度，对多种DAAs开展直接对比的高质量经济学研究；同时，在敏感性分析中考虑药品价格、药物SVR率和健康状态效用值等
参数对基础分析结果稳健性的影响，以增加研究结果的可信度。
关键词 丙型病毒性肝炎；直接抗病毒药物；模型方法学；经济性评价；系统评价

Systematic Review of the Economics of the Second-generation Direct-acting Antiviral Agents in the
Treatment of Hepatitis C
MENG Rui ，RUI Mingjun ，MA Yue ，JIN Min ，CHEN Pingyu （1. School of International Pharmaceutical
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Business，China Pharmaceutical University，Nanjing 211198，China；2. Pharmacoeconomic Evaluation Research
Center，China Pharmaceutical University，Nanjing 211198，China）
ABSTRACT OBJECTIVE：To systematically evaluate the pharmacoeconomic research of the second-generation direct-acting
antiviral agents（DAAs）in the treatment of hepatitis C，and to provide methodological suggestions for economic research，and to
provide decision-making reference for the adjustment of medical insurance catalogues and market access. METHODS：Retrieved
from PubMed，EMbase，the Cochrane library，CNKI，Wanfang database and VIP，the pharmacoeconomic researches of the
second-generation DAAs for hepatitis C were collected during Jan. 2015-Jan. 2020. The quality of included studies were evaluated
with the checklist about Consolidated Health Economics Evaluation Reporting Standards（CHEERS），and the data were extracted
and analyzed quantitatively. RESULTS：A total of 14 studies were included，and the standard coincidence rate ranged from 79.2％
to 95.8％；the overall quality was relatively high. Thirteen（92.9％）studies had compared the economics of different treatment
schemes from the perspective of the payer by using the Markov model and the lifetime study time limit. Compared with the
second-generation DAAs treatment schemes based on sofosbuvir，all the research results showed that Ombitasvir combined with
Dasabuvir（3D），EBR/GZR and GLE/PIB were more economical in the target countries；single factor sensitivity analysis showed
that the research results were more sensitive to the three parameters of drug price，drug SVR rate and health status utility value.
CONCLUSIONS：Among the second-generation DAAs for hepatitis C，the three regimens of 3D，EBR/GZR and GLE/PIB are
more economical. It is recommended that future research on the economics of medicines for hepatitis C adopted dynamic model and
the research perspective of the whole society to carry out direct high-quality economic research on a variety of DAAs；at the same
time，considered the effects of drug price，drug SVR rate and
Δ 基金项目：中国博士后科学基金（No.2020M681784）；江苏高校
health status utility value on the robustness of basic analysis
哲学社会科学研究一般项目（No.2020SJA0070）
results in sensitivity analysis in order to increase the credibility
＊硕士研究生。研究方向：药物经济学评价。电话：025-86185038。
of the research results.
E-mail：981095209@qq.com
# 通信作者：研究员，博士。研究方向：药物经济学评价。电话： KEYWORDS Hepatitis C； Direct-acting antiviral agents；
025-86185038。E-mail：chenpingyu220@163.com Model methodology；Economic evaluation；Systematic review

·2882 · China Pharmacy 2020 Vol. 31 No. 23 中国药房 2020年第31卷第23期