Page 51 - 《中国药房》2023年2期

·药物经济学·

地舒单抗和特立帕肽治疗中国女性绝经后骨质疏松症的成本-效
用分析 Δ

1#
杜桂平 ，李玉坤 ，李 敏 ，薛 鹏 ，刘 岩 ，刘国强 （1. 河北医科大学第三医院临床药学部，石家庄
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050051；2.河北医科大学第三医院内分泌二科，石家庄 050051）
中图分类号 R956 文献标志码 A 文章编号 1001-0408（2023）02-0173-06
DOI 10.6039/j.issn.1001-0408.2023.02.09
摘 要 目的 评价地舒单抗和特立帕肽治疗中国女性绝经后骨质疏松症的经济性，为相关决策提供参考。方法 从我国医疗卫
生体系角度出发，利用Excel 2003软件建立马尔科夫模型，采用成本-效用分析法评价地舒单抗和特立帕肽分别联合碳酸钙D3片
治疗中国女性绝经后骨质疏松症的经济性。药物治疗效果来自网状荟萃结果，成本和健康效用值数据来自已发表的文献。模型
的循环周期为1年，模拟时限为患者终身。采用单因素敏感性分析和概率敏感性分析评价模型参数变化对结果稳健性的影响；并
通过情境分析探讨特立帕肽组采用国产药的药品成本的经济性，特立帕肽组药物后遗效应对结果的影响以及特立帕肽停药后序
贯使用地舒单抗治疗的经济性。结果 地舒单抗方案的效果优于特立帕肽方案[13.24 质量调整生命年（QALYs）vs.12.96 QALYs]，
同时其成本也更低（51 224.64元vs.167 102.67元），地舒单抗方案为绝对优势方案。单因素敏感性分析结果显示，特立帕肽注射液
的成本和贴现率对结果的影响较大。概率敏感性分析结果显示，使用3倍我国2021年人均国内生产总值作为意愿支付阈值时，地
舒单抗方案具有经济性的概率为93.5%。情境分析结果显示，无论特立帕肽方案换用国产药的药品成本，还是考虑特立帕肽的药
物后遗效应，又或是特立帕肽用药2年后序贯使用地舒单抗治疗，地舒单抗方案都是绝对优势方案。结论 地舒单抗联合碳酸钙
D3片治疗中国女性绝经后骨质疏松症较特立帕肽联合碳酸钙D3片更具经济性。
关键词 地舒单抗；特立帕肽；中国女性；绝经后骨质疏松症；成本-效用分析

Cost-utility analysis of denosumab and teriparatide in the treatment of postmenopausal osteoporosis in
Chinese women
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DU Guiping ，LI Yukun ，LI Min ，XUE Peng ，LIU Yan ，LIU Guoqiang（1. Dept. of Clinical Pharmacy， the
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Third Hospital of Hebei Medical University， Shijiazhuang 050051， China；2. Dept. Two of Endocrinology， the
Third Hospital of Hebei Medical University， Shijiazhuang 050051， China）
ABSTRACT OBJECTIVE To evaluate the cost-effectiveness of denosumab and teriparatide in the treatment of postmenopausal
osteoporosis in Chinese women， and provide reference for relevant decision-making. METHODS From the perspective of health
system in China， Excel 2003 was used to establish Markov model， and cost-utility analysis was used to evaluate the cost-
effectiveness of denosumab or teriparatide combined with Calcium carbonate D3 tablets in the treatment of postmenopausal
osteoporosis in Chinese women. Pharmacotherapy effects were obtained with network meta-analysis， and cost and health utility
value data were obtained from published literature. The model cycle was 1 year， and the simulation time limit was the patient’s
lifetime. Univariate sensitivity analysis and probabilistic sensitivity analysis were used to evaluate the effects of model parameter
changes on the robustness of the results. Through scenario analysis， the cost-effectiveness of domestic drug cost used as drug cost
of terlipatide group was discussed； the influence of residual effects of teriparatide on the results and the cost-effectiveness of
sequential use of desumamab after terlipatide withdrawal were also discussed. RESULTS The effect of denosumab regimen was
better than that of terlipatide regimen [13.24 quality-adjusted life years （QALYs） vs. 12.96 QALYs]， with lower cost （51 224.64
yuan vs. 167 102.67 yuan）， denosumab regimen was the absolutely superior regimen. The results of single factor sensitivity analysis
showed that the cost and discount rate of Terlipatide injection had greater impact on the results. The results of probability sensitivity
analysis showed that when three times of China’s per capita
Δ 基金项目 河北省自然科学基金资助项目（No.H2021206407）
gross domestic product （GDP） in 2021 was used as the
＊第一作者 硕士研究生。研究方向：药物经济学。E-mail：
1441360375@qq.com threshold of willingness to pay， the probability of cost-
# 通信作者 主任药师，硕士生导师，硕士。研究方向：药物经济 effectiveness of denosumab regimen was 93.5%. The results of
学、合理用药、卫生技术评估。E-mail：liugq1223@sohu.com scenario analysis showed that， whether the drug cost of

中国药房 2023年第34卷第2期 China Pharmacy 2023 Vol. 34 No. 2 · 173 ·