{"title":"伊朗治疗严重活动性类风湿性关节炎的托珠单抗与阿达木单抗的成本效益分析。","authors":"Yalda Metghalchi, Neda Yaghoubi, Nazila Yousefi, Razieh Ahmadi, Alireza Kargar, Marzieh Zargaran, Soheila Rezaei","doi":"10.1186/s12962-024-00592-7","DOIUrl":null,"url":null,"abstract":"<p><strong>Background and objective: </strong>This study aimed to determine the cost-effectiveness of Tocilizumab (TCZ) compared with Adalimumab (ADA) in patients with Rheumatoid Arthritis (RA), who had not responded to methotrexate (MTX), from a societal perspective in Iran.</p><p><strong>Method: </strong>To conduct the cost-utility analysis, using an individual microsimulation Markov model, a hypothetical cohort of 1,000 patients was evaluated over a lifetime horizon. The efficacy and safety of each treatment were estimated using the American College of Rheumatology (ACR) criteria to determine the continuation or switching of treatment every six months. 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引用次数: 0
摘要
背景和目的：本研究旨在从伊朗社会的角度出发，确定对甲氨蝶呤（MTX）无效的类风湿关节炎（RA）患者使用托昔单抗（TCZ）与阿达木单抗（ADA）相比的成本效益：为了进行成本效用分析，我们使用个体微观模拟马尔可夫模型，对一个由 1000 名患者组成的假定队列进行了终生评估。根据美国风湿病学会（ACR）的标准，对每种治疗方法的疗效和安全性进行估算，以决定每六个月继续治疗或更换治疗方法。根据健康评估问卷（HAQ）的评分记录治疗反应，并将其映射为效用值，以确定每种治疗方法的 QALY 收益。所有与疾病相关的直接和间接成本以及视角都根据社会视角纳入其中。进行了确定性和概率敏感性分析，以评估模型的稳健性：研究结果估计，TCZ 是一种更具成本效益的治疗方案，概率为 76%。与 ADA 相比，TCZ 的成本更高（6990 美元对 6608 美元），获得的 QALY 更高（4.24 对 3.95），增量成本效益比（ICER）为 1301 美元，低于伊朗的支付意愿阈值 1448 美元：本研究提供了令人信服的证据，证明在伊朗治疗活动性重度 RA 时，TCZ 与 ADA 相比具有成本效益。
Cost-effectiveness analysis of Tocilizumab compared to Adalimumab in the treatment of severe active rheumatoid arthritis in Iran.
Background and objective: This study aimed to determine the cost-effectiveness of Tocilizumab (TCZ) compared with Adalimumab (ADA) in patients with Rheumatoid Arthritis (RA), who had not responded to methotrexate (MTX), from a societal perspective in Iran.
Method: To conduct the cost-utility analysis, using an individual microsimulation Markov model, a hypothetical cohort of 1,000 patients was evaluated over a lifetime horizon. The efficacy and safety of each treatment were estimated using the American College of Rheumatology (ACR) criteria to determine the continuation or switching of treatment every six months. Treatment responses were captured based on Health Assessment Questionnaire (HAQ) scores and mapped into utility values to determine QALY gained for each treatment. All direct and indirect costs associated with the disease and perspective were included according to societal perspective. Deterministic and Probabilistic sensitivity analyses were performed to assess the robustness of the model.
Results: The result of the study estimated that TCZ is a more cost-effective treatment option, with a probability of 76%. TCZ was associated with a higher cost ($6,990 versus $6,608) and higher QALYs gained (4.24 versus 3.95) compared to ADA with an incremental cost-effectiveness ratio (ICER) of USD 1,301, which is below the willingness-to-pay threshold of 1,448 USD in Iran.
Conclusion: This study provides convincing evidence of the cost-effectiveness of TCZ compared to ADA in the treatment of active severe RA in Iran.
期刊介绍：
Cost Effectiveness and Resource Allocation is an Open Access, peer-reviewed, online journal that considers manuscripts on all aspects of cost-effectiveness analysis, including conceptual or methodological work, economic evaluations, and policy analysis related to resource allocation at a national or international level. Cost Effectiveness and Resource Allocation is aimed at health economists, health services researchers, and policy-makers with an interest in enhancing the flow and transfer of knowledge relating to efficiency in the health sector. Manuscripts are encouraged from researchers based in low- and middle-income countries, with a view to increasing the international economic evidence base for health.
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