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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 compare the cost-effectiveness of etanercept combined with methotrexate to methotrexate plus placebo in the treatment of rheumatoid arthritis and to provide references for clinical practice.Methods Decision tree model was developed to estimate the cost-effectiveness from the perspective of the health care system by TreeAge Pro 2016 software.The cost-effectiveness of the two treatments were compared by incremental analysis,and the robustness of the results were analyzed by sensitivity analysis.Results The cost of etanercept combined methotrexate group in one year duration was ￥212 692,the effective rate (ACR50) was 66.4％;the cost of methotrexate combined with placebo group in one year duration was ￥572,the effective rate (ACR50) was 40.6％.The incremental cost-effectiveness ratio of two groups was ￥818 000/person,and the sensitivity analysis showed that the results were robust.Conclusion Etanercept combined methotrexate is significant more effective than methotrexat.But the cost of etanercept combined methotrexate is too high to afford and is not economical compared to methotrexate.