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·药物经济学·


        “新四联”背景下伊伐布雷定治疗CHF的药物经济学评价
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          陈琮玲    1, 2* ,吴 韩 ,周 洁 ,张若彬 ,张晋萍 ,鲍 雪 ,杨 贤 (1.南京鼓楼医院药学部,南京 210008;
                           3
                                                                       1 #
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          2.中国药科大学基础医学与临床药学学院,南京 211198;3.南京鼓楼医院心脏科,南京 210008)
          中图分类号  R956;R972      文献标志码  A      文章编号  1001-0408(2024)01-0063-06
          DOI  10.6039/j.issn.1001-0408.2024.01.11
          摘  要  目的  从卫生体系角度出发,评价伊伐布雷定在“新四联”背景下治疗慢性心力衰竭(CHF)的经济性。方法  基于真实世
          界队列研究数据,根据CHF疾病自然发展进程构建Markov模型,循环周期设为3个月,研究时限为20年,贴现率为5%;以质量调
          整生命年(QALY)和增量成本-效果比(ICER)为产出指标,采用成本-效用分析法评价伊伐布雷定联合“新四联”方案相较于“新四
          联”方案治疗CHF的经济性,并通过单因素敏感性分析、概率敏感性分析验证基础分析结果的稳健性。结果  基础分析结果显示,
          伊伐布雷定联合“新四联”方案相较于“新四联”方案的 ICER 为 165 065.54 元/QALY,低于以 3 倍我国 2022 年人均国内生产总值
         (GDP)作为的意愿支付(WTP)阈值(257 094元/QALY)。单因素敏感性分析结果显示,贴现率对模型的稳健性影响最大。概率敏
          感性分析结果显示,在本研究的WTP阈值下,伊伐布雷定联合“新四联”方案具有经济性的概率为59.50%。结论  当采用3倍我国
          2022年人均GDP(257 094元/QALY)作为WTP阈值时,伊伐布雷定联合“新四联”方案治疗CHF具有经济性。
          关键词  慢性心力衰竭;伊伐布雷定;新四联;Markov模型;药物经济学

          Pharmacoeconomics of ivabradine in the treatment of CHF in the context of “Quadruple Therapy”
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          CHEN Congling ,WU Han ,ZHOU Jie ,ZHANG Ruobin ,ZHANG Jinping ,BAO Xue ,YANG Xian                  1
                                               1, 2
         (1.  Dept.  of  Pharmacy,  Nanjing  Drum  Tower  Hospital,  Nanjing  210008,  China;2.  School  of  Basic  Medicine
          and  Clinical  Pharmacy,  China  Pharmaceutical  University,  Nanjing  211198,  China;3.  Dept.  of  Cardiology,
          Nanjing Drum Tower Hospital, Nanjing 210008, China)
          ABSTRACT   OBJECTIVE To evaluate the cost-effectiveness of ivabradine in the treatment of chronic heart failure (CHF) in the
          context  of “Quadruple  Therapy”  from  the  perspective  of  the  health  system.  METHODS  Based  on  real-world  cohort  data,  the
          Markov model was constructed according to the natural progression of CHF, with a cycle time of 3 months, a study timeframe of
          20 years, and a discount rate of 5%. Using quality-adjusted life year (QALY) and incremental cost-effectiveness ratios (ICER) as
          the  output  indexes,  the  cost-utility  analysis  was  used  to  evaluate  the  cost-effectiveness  of  ivabradine  in  combination  with  the
         “Quadruple Therapy”  regimen,  compared  with  the “Quadruple Therapy”  regimen  for  the  treatment  of  CHF,  and  the  robustness  of
          the  results  of  the  base  analysis  was  verified  by  univariate  sensitivity  analysis  and  probabilistic  sensitivity  analysis.  RESULTS  The
          results  of  the  base  analysis  showed  that  the  ICER  of  ivabradine  combined  with  the “Quadruple Therapy”  regimen  was  165  065.54
          yuan/QALY,  compared  with  the “Quadruple  Therapy”  regimen,  which  was  lower  than  the  willingness-to-pay (WTP)  threshold
         (257 094 yuan/QALY) based on 3 times of China’s gross domestic product (GDP) per capita in 2022. The results of the univariate
          sensitivity analysis showed that the discount rate had the greatest impact on the robustness of the model. The probabilistic sensitivity
          analysis  showed  that  the  probability  that  the  ivabradine  combined  with  the “Quadruple  Therapy”  regimen  was  cost-effective  under
          the WTP threshold in this study was 59.50%. CONCLUSIONS When using 3 times China’s 2022 GDP per capita (257 094 yuan/
          QALY)  as  the  WTP  threshold,  the  combination  of  ivabradine  and  the “Quadruple  Therapy”  regimen  for  treating  CHF  is  cost-
          effective.
          KEYWORDS    chronic heart failure; ivabradine; Quadruple Therapy; Markov model; pharmacoeconomics



              慢性心力衰竭(chronic heart failure,CHF)是心脏疾          研究证实,以血管紧张素受体-脑啡肽酶抑制剂(angio‐
          病的终末阶段,药物治疗是其主要治疗手段。大型临床                           tensin receptor-neprilysin inhibitor,ARNI)或血管紧张素
                                                             转化酶抑制剂(angiotensin converting enzyme inhibitor,
             Δ 基金项目 国家自然科学基金项目(No.81970296);南京市卫生
                                                             ACEI)/血管紧张素Ⅱ受体拮抗剂(angiotensin Ⅱ recep‐
          科技发展专项资金项目(No.JQX20006)
             * 第一作者 硕 士 研 究 生 。 研 究 方 向 :临 床 药 学 。 E-mail:   tor  blocker,ARB)、钠 - 葡 萄 糖 共 转 运 蛋 白 2 抑 制 剂
          1259791348@qq.com                                 (sodium-glucose cotransporter 2 inhibitor,SGLT2i)、β 受
             # 通信作者 主管药师,硕士。研究方向:心血管药物治疗。                    体阻滞剂和盐皮质激素受体拮抗剂(mineralocorticoid
          E-mail:yangxian-gp4@163.com                        receptor antagonist,MRA)为基础的 CHF“新四联”药物


          中国药房  2024年第35卷第1期                                                  China Pharmacy  2024 Vol. 35  No. 1    · 63 ·
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