Wu Bin, Song Yang, Leng Lin, Bucala Richard, Lu Liang-jing
Clinical Outcomes and Economics Group, Department of Pharmacy, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Department of Rheumatology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Clin Exp Rheumatol. 2015 Jan-Feb;33(1):20-6. Epub 2014 Dec 1.
This paper aims to explore the cost-effectiveness of reduced doses or discontinuation of etanercept biosimilar (Yisaipu) in patients with moderately active rheumatoid arthritis (RA).
A discrete event simulation model was developed to project lifetime medical costs and quality-adjusted life-years (QALYs) in moderately active RA. Strategies starting with Yisaipu 50 mg/week for nine months following Yisaipu 50 mg/week, 25 mg/week or MTX maintenance were compared. Resource consumptions related to RA were estimated from the perspective of the Chinese health care system. An endpoint of the American College of Rheumatology (ACR) response was used to estimate the utility scores. Uncertainty in model parameters was analysed by sensitivity analyses.
When using ACR as an endpoint for determining successful treatment, strategies starting with Yisaipu 50 mg/week for nine months following Yisaipu 50 mg/week or 25 mg/week maintenance showed the greatest number of QALYs gained (nearly 11.9 and 11.3 with or without rituximab after the failure of Yisaipu, respectively). If decision makers use a threshold of 3×the per capita GDP of China or Shanghai City in 2012, then the strategies most likely to be cost-effective are initial treatment with Yisaipu 50 mg/week for nine months following MTX maintenance and Yisaipu 25 mg/week maintenance, respectively. Results were sensitive to the cost of Yisaipu.
The analysis indicates that, in China, replacing branded etanercept with Yisaipu is likely to be a cost-effective strategy in patients with moderately active RA.
本文旨在探讨降低剂量或停用依那西普生物类似药（益赛普）治疗中度活动类风湿关节炎（RA）患者的成本效益。
建立离散事件模拟模型，预测中度活动RA患者的终身医疗成本和质量调整生命年（QALY）。比较了益赛普50mg/周起始治疗9个月后，分别采用益赛普50mg/周、25mg/周或甲氨蝶呤维持治疗的策略。从中国医疗保健系统的角度估算与RA相关的资源消耗。采用美国风湿病学会（ACR）反应终点估算效用得分。通过敏感性分析评估模型参数的不确定性。
以ACR作为确定治疗成功的终点时，益赛普50mg/周起始治疗9个月后，分别采用益赛普50mg/周或25mg/周维持治疗的策略获得的QALY数量最多（益赛普治疗失败后，使用或不使用利妥昔单抗分别获得近11.9和11.3个QALY）。如果决策者采用2012年中国或上海市人均GDP的3倍作为阈值，那么最有可能具有成本效益的策略分别是甲氨蝶呤维持治疗后采用益赛普50mg/周起始治疗9个月和益赛普25mg/周维持治疗。结果对益赛普的成本敏感。
分析表明，在中国，用益赛普替代原研依那西普可能是治疗中度活动RA患者的一种具有成本效益的策略。
