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目的评价依那西普联合甲氨蝶呤与甲氨蝶呤联合安慰剂比较治疗类风湿关节炎的成本-效果,为医疗保健决策提供参考。方法从医疗保健系统角度出发,采用TreeAge Pro 2016软件构建决策树模型进行成本-效果分析。采用增量分析比较2种治疗方案的成本-效果,并进行敏感性分析。结果经过1年治疗后,依那西普联合甲氨蝶呤组的成本为212 692元,疗效(ACR50)为66.4%;甲氨蝶呤联合安慰剂组的成本为572元,疗效(ACR50)为40.6%;两组的增量成本-效果比为81.8万元/人,敏感性分析显示结果稳健。结论依那西普联合甲氨蝶呤治疗类风湿关节炎的疗效优于甲氨蝶呤,但依那西普联合甲氨蝶呤治疗方案的成本过高,不具有经济性优势。
Objective To evaluate the cost-effectiveness of etanercept combined with methotrexate and methotrexate in combination with placebo in the treatment of rheumatoid arthritis, and to provide a reference for health care decision-making. Methods From the perspective of the health care system, we used TreeAge Pro 2016 software to construct a decision tree model for cost-effectiveness analysis. An incremental analysis was used to compare the cost-effectiveness of the two treatment options and to conduct a sensitivity analysis. Results After 1 year of treatment, the cost of Etanercept and methotrexate group was 212 692 yuan, and the ACR50 was 66.4%. The cost of methotrexate combined with placebo group was 572 yuan, and the efficacy (ACR50) Was 40.6%. The incremental cost-effectiveness ratio of the two groups was 818,000 yuan per person. The sensitivity analysis showed that the result was steady. Conclusions Etanercept combined with methotrexate is superior to methotrexate in the treatment of rheumatoid arthritis, but the cost of etanercept combined with methotrexate is not cost-effective.