年龄相关性黄斑变性的治疗选择：从巴西公共卫生系统角度进行的预算影响分析
Treatment Options for Age-Related Macular Degeneration: A Budget Impact Analysis from the Perspective of the Brazilian Public Health System.
作者信息
Elias Flávia Tavares Silva, Silva Everton Nunes da, Belfort Rubens, Silva Marcus Tolentino, Atallah Álvaro Nagib
机构信息
Oswaldo Cruz Foundation, Brasília, Distrito Federal, Brazil.
University of Brasilia, Brasília, Distrito Federal, Brazil.
出版信息
PLoS One. 2015 Oct 12;10(10):e0139556. doi: 10.1371/journal.pone.0139556. eCollection 2015.
BACKGROUND
Age-related macular degeneration (AMD) is a disease that causes reduced visual acuity and blindness. The new treatment options for AMD are not provided by the Brazilian public health system.
OBJECTIVE
To conduct a budget impact analysis of three scenarios for the introduction of AMD treatments: all the medications (verteporfin, ranibizumab, and bevacizumab-the reference scenario), ranibizumab alone, and bevacizumab alone.
METHODS
The basic assumption was that the Brazilian public health system would treat the entire target population with AMD aged > 70 years between 2008 and 2011. The size of the population of interest was estimated from official population projections and the prevalence of the disease was obtained from a systematic review. Medication prices were estimated by weighting their market values with correction factors to take account of the public procurement policy. The possibility of aliquoting bevacizumab was also considered. A panel of experts was consulted to estimate the market share of the different medications for the reference scenario. The incremental costs of the ranibizumab-alone and bevacizumab-alone scenarios compared to the reference scenario were calculated. Univariate sensitivity analyses were run to check the robustness of the model.
RESULTS
In four years, the Brazilian public health system would have treated 1,136,349 individuals with AMD. The annual costs of treating one patient would have been US$476.65 for bevacizumab, US$11,469.39 for ranibizumab, and US$4,376.28 for verteporfin. The incremental cost of the ranibizumab-alone scenario would have been US$1,878,318,056.00 in four years, while the incremental cost for the bevacizumab-alone scenario would have been a reduction of US$4,978,326,359.00 (i.e., a cost saving) in the same period. The bevacizumab-alone option was found to represent a cost saving across sensitivity analyses.
CONCLUSION
The introduction of bevacizumab for the treatment of AMD is recommended for the Brazilian Public Health System.
背景
年龄相关性黄斑变性（AMD）是一种导致视力下降和失明的疾病。巴西公共卫生系统未提供AMD的新治疗选择。
目的
对引入AMD治疗的三种方案进行预算影响分析：所有药物（维替泊芬、雷珠单抗和贝伐单抗——参考方案）、仅使用雷珠单抗、仅使用贝伐单抗。
方法
基本假设是巴西公共卫生系统将在2008年至2011年期间治疗所有年龄大于70岁的AMD目标人群。根据官方人口预测估算目标人群规模，并通过系统评价获得疾病患病率。通过用校正因子加权其市场价值来估算药物价格，以考虑公共采购政策。还考虑了贝伐单抗分装的可能性。咨询了一个专家小组以估算参考方案中不同药物的市场份额。计算了仅使用雷珠单抗和仅使用贝伐单抗方案与参考方案相比的增量成本。进行单变量敏感性分析以检验模型的稳健性。
结果
四年内，巴西公共卫生系统将治疗1,136,349例AMD患者。治疗一名患者的年度成本，贝伐单抗为476.65美元，雷珠单抗为11,469.39美元，维替泊芬为4,376.28美元。仅使用雷珠单抗方案的增量成本在四年内将为1,878,318,056.00美元，而仅使用贝伐单抗方案的增量成本在同一时期将减少4,978,326,359.00美元（即成本节约）。在敏感性分析中发现仅使用贝伐单抗方案可节省成本。
结论
建议巴西公共卫生系统引入贝伐单抗治疗AMD。
Zotero 插件