Guest Julian F, Clegg John P, Helter Marianne T
Catalyst Health Economics Consultants, Northwood, Middlesex, UK.
Curr Med Res Opin. 2008 Jul;24(7):1841-52. doi: 10.1185/03007990802102349. Epub 2008 May 27.
To estimate the cost-effectiveness of macrogol 4000 compared to lactulose in the treatment of chronic functional constipation, from the perspective of the National Health Service (NHS) in the UK.
A decision model depicting the management of chronic functional constipation was constructed using clinical outcomes and resource use values derived from patients suffering from chronic functional constipation in The Health Improvement Network (THIN) Database. The model was used to estimate the cost-effectiveness of a general practitioner (GP) prescribing macrogol 4000 relative to lactulose to treat adults >/=18 years of age suffering from chronic functional constipation.
Forty-two per cent (95% confidence interval [CI]: 38%; 46%) of macrogol 4000-treated patients are expected to be successfully treated within 3 months after starting treatment, compared to 31% (95% CI: 27%; 37%) of lactulose-treated patients. Patients' health status at 3 months was estimated to be 0.213 (95% CI: 0.200; 0.223) and 0.210 (95% CI: 0.197; 0.220) quality-adjusted life years (QALYs) in the macrogol 4000 and lactulose groups, respectively. The total 3-monthly NHS cost of treating patients with macrogol 4000 or lactulose was estimated to be pound115 (95% CI: pound98; pound132) and pound102 (95% CI: pound86; pound119), respectively. Hence, the cost per QALY gained with macrogol 4000 was estimated to be pound4333.
Within the limitations of the model, treatment with macrogol 4000 relative to lactulose is expected to increase the probability of being successfully treated by 35% at 3 months (p<0.0001), although this yields only a 1% improvement in health gain. Nevertheless, macrogol 4000 affords a cost-effective addition to the range of laxatives available for this potentially resource-intensive condition, since it is clinically more effective than lactulose and the cost-effective strategy from the perspective of the NHS.
从英国国家医疗服务体系（NHS）的角度，评估聚乙二醇4000与乳果糖相比治疗慢性功能性便秘的成本效益。
利用从健康改善网络（THIN）数据库中患有慢性功能性便秘的患者所获得的临床结果和资源使用值，构建一个描述慢性功能性便秘管理的决策模型。该模型用于估计全科医生（GP）开具聚乙二醇4000相对于乳果糖治疗≥18岁患有慢性功能性便秘成年人的成本效益。
预计开始治疗后3个月内，42%（95%置信区间[CI]：38%；46%）接受聚乙二醇4000治疗的患者将成功治愈，相比之下，接受乳果糖治疗的患者为31%（95%CI：27%；37%）。聚乙二醇4000组和乳果糖组患者在3个月时的健康状况估计分别为0.213（95%CI：0.200；0.223）和0.210（95%CI：0.197；0.220）质量调整生命年（QALY）。用聚乙二醇4000或乳果糖治疗患者的3个月NHS总成本估计分别为115英镑（95%CI：98英镑；132英镑）和102英镑（95%CI：86英镑；119英镑）。因此，聚乙二醇4000每获得一个QALY的成本估计为4333英镑。
在模型的局限性内，与乳果糖相比，聚乙二醇4000治疗预计在3个月时成功治疗的概率提高35%（p<0.0001），尽管这仅使健康获益提高1%。然而，聚乙二醇4000为这种可能资源密集型疾病的可用泻药范围提供了一种具有成本效益的补充，因为它在临床上比乳果糖更有效，并且从NHS的角度来看是具有成本效益的策略。
