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地塞米松联合硼替佐米与来那度胺治疗新诊断多发性骨髓瘤的

成本-效用分析 Δ

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黄 丹 ，朱元元 ，肖 悦 ，刘秋莎 ，刘 沙 ，刘 娟 ，沈正泽 （1.重庆医科大学附属永川医院药学部，重庆
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402160；2.重庆医科大学药学院，重庆 400016；3.重庆医科大学附属永川医院血液内科，重庆 402160）
中图分类号 R956 文献标志码 A 文章编号 1001-0408（2022）16-2001-06
DOI 10.6039/j.issn.1001-0408.2022.16.15
摘 要 目的 评估包含硼替佐米的方案治疗中国新诊断多发性骨髓瘤患者的经济性。方法 从我国卫生体系角度出发，基于
SWOG S0777研究构建Markov模型，模拟时限为10年，循环周期参考治疗周期设定，以质量调整生命年（QALYs）为效用指标，效
用和成本均按5％的贴现率进行贴现，意愿支付（WTP）阈值设定为3倍2021年我国人均国内生产总值（GDP，242 928元/QALY）。
采用成本-效用分析比较地塞米松联合硼替佐米与来那度胺（VRD）方案对比地塞米松联合来那度胺（RD）方案的增量成本-效果
比（ICER），并对模型的不确定性进行敏感性分析。结果 基础分析结果显示，相比于RD方案，VRD方案可多获得0.65 QALYs，但
其治疗成本比 RD 方案多花费 135 782.77 元，ICER 值为 206 623.35 元/QALY，低于本研究设定的 WTP 阈值，VRD 方案具有经济
性。单因素敏感性分析显示，无进展生存期的健康效用值对结果影响最大，效用值的降低可能会使ICER高于本研究设定的WTP
阈值，导致VRD方案不再具有经济学优势。在3倍2021年我国人均GDP的WTP阈值下，VRD方案具有经济性的概率为86.5％；
且随着WTP阈值的增加，VRD方案更具经济性的概率还会有所增加。结论 在3倍2021年我国人均GDP的WTP阈值下，与RD方
案相比，VRD方案在中国治疗新诊断多发性骨髓瘤具有经济性。
关键词 硼替佐米；来那度胺；地塞米松；多发性骨髓瘤；药物经济学；成本-效用分析

Cost-utility analysis of dexamethasone combined with bortezomib and lenalidomide in the treatment of
newly diagnosed multiple myeloma
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HUANG Dan ，ZHU Yuanyuan ，XIAO Yue ，LIU Qiusha ，LIU Sha ，LIU Juan ，SHEN Zhengze（1. Dept. of
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Pharmacy，Yongchuan Hospital of Chongqing Medical University，Chongqing 402160，China；2. School of
Pharmacy，Chongqing Medical University，Chongqing 400016，China；3. Dept. of Hematology，Yongchuan
Hospital of Chongqing Medical University，Chongqing 402160，China）
ABSTRACT OBJECTIVE To evaluate the cost-utility of regimen containing bortezomib in the treatment of newly diagnosed
multiple myeloma in China. METHODS From the perspective of China’s health system，Markov model was constructed based on
SWOG S0777 clinical trial. The simulation time limit was 10 years，and the cycle was set with reference to the treatment cycle.
Taking quality adjusted life years（QALYs）as the utility index，the utility and cost were discounted at a discount rate of 5％；the
willingness to pay （WTP）threshold was set to be 3 times of China’s per capita gross domestic product（GDP）in 2021（242 928
yuan/QALY）. The incremental cost-utility ratio （ICER） of dexamethasone combined with bortezomib and lenalidomide （VRD）
versus dexamethasone combined with lenalidomide （RD） were compared with cost-utility analysis. The sensitivity analysis was
performed for the uncertainty of the model. RESULTS Results of baseline analysis showed that VRD regimen could obtain 0.65
more QALYs than RD scheme，but its treatment cost was 135 782.77 yuan more than RD regimen，ICER was 206 623.35 yuan/
QALY，which was lower than the WTP threshold set in this study，VRD regimen was cost-effective. Single factor sensitivity
analysis showed that the health utility value in progressive free survival had the greatest impact on the results，the decrease of
utility value would make the ICER higher than the WTP threshold，and VRD regimen would no longer have advantages. Under the
WTP threshold of 3 times of China’s per capita GDP in 2021，the probability of VRD regimen being cost-effective was 86.5％；
with the increase of WTP threshold，the possibility of VRD regimen becoming more cost-effective than RD regimen would
increase. CONCLUSIONS Under the WTP threshold of 3
Δ 基金项目 重庆市卫生健康委医学科研项目（No.2022WS-
times of China’s per capita GDP in 2021，compared with RD
JK081）；重庆市科卫联合医学科研项目（No.2022MSXM047）；重庆医科
大学未来医学青年创新团队发展支持计划项目（No.W0067） regimen，VRD regimen is cost-effective in the treatment of
＊第一作者 主管药师，硕士。研究方向：临床药学、药物经济学。 newly diagnosed multiple myeloma in China.
E-mail：397409177@qq.com KEYWORDS bortezomib； lenalidomide； dexamethasone；
# 通信作者 副主任药师，讲师，硕士。研究方向：临床药学。 multiple myeloma；pharmacoeconomics；cost-utility analysis
E-mail：317229355@qq.com

中国药房 2022年第33卷第16期 China Pharmacy 2022 Vol. 33 No. 16 ·2001 ·