Fisher Mark, Walker Andrew, Falqués Meritxell, Moya Miguel, Rance Mark, Taylor Douglas, Lindner Leandro
WG Consulting Healthcare Limited, High Wycombe, UK.
Glasgow University, Glasgow, UK.
Eur J Health Econ. 2016 Dec;17(9):1091-1100. doi: 10.1007/s10198-015-0747-0. Epub 2016 Jan 4.
Presently, linaclotide is the only EMA-approved therapy indicated for the treatment of irritable bowel syndrome with constipation (IBS-C). This study sought to determine the cost-effectiveness of linaclotide compared to antidepressants for the treatment of adults with moderate to severe IBS-C who have previously received antispasmodics and/or laxatives. A Markov model was created to estimate costs and QALYs over a 5-year time horizon from the perspective of NHS Scotland. Health states were based on treatment satisfaction (satisfied, moderately satisfied, not satisfied) and mortality. Transition probabilities were based on satisfaction data from the linaclotide pivotal studies and Scottish general all-cause mortality statistics. Treatment costs were calculated from the British National Formulary. NHS resource use and disease-related costs for each health state were estimated from Scottish clinician interviews in combination with NHS Reference costs. Quality of life was based on EQ-5D data collected from the pivotal studies. Costs and QALYs were discounted at 3.5 % per annum. Uncertainty was explored through extensive deterministic and probabilistic sensitivity analyses. Over a 5-year time horizon, the additional costs and QALYs generated with linaclotide were £659 and 0.089, resulting in an incremental cost-effectiveness ratio of £7370 per QALY versus antidepressants. Based on the probabilistic sensitivity analysis, the likelihood that linaclotide was cost-effective at a willingness to pay of £20,000 per QALY was 73 %. Linaclotide can be a cost-effective treatment for adults with moderate-to-severe IBS-C who have previously received antispasmodics and/or laxatives in Scotland.
目前，利那洛肽是唯一经欧洲药品管理局（EMA）批准用于治疗便秘型肠易激综合征（IBS-C）的疗法。本研究旨在确定与抗抑郁药相比，利那洛肽治疗先前已接受过抗痉挛药和/或泻药治疗的中重度IBS-C成人患者的成本效益。构建了一个马尔可夫模型，从苏格兰国民保健服务（NHS）的角度估计5年时间范围内的成本和质量调整生命年（QALY）。健康状态基于治疗满意度（满意、中度满意、不满意）和死亡率。转移概率基于利那洛肽关键研究中的满意度数据和苏格兰全因死亡率统计数据。治疗成本根据《英国国家处方集》计算。通过对苏格兰临床医生的访谈并结合NHS参考成本，估计了每个健康状态下的NHS资源使用和疾病相关成本。生活质量基于关键研究中收集的EQ-5D数据。成本和QALY按每年3.5%进行贴现。通过广泛的确定性和概率敏感性分析探讨不确定性。在5年时间范围内，利那洛肽产生的额外成本和QALY分别为659英镑和0.089，与抗抑郁药相比，增量成本效益比为每QALY 7370英镑。基于概率敏感性分析，利那洛肽在每QALY支付意愿为20000英镑时具有成本效益的可能性为73%。在苏格兰，对于先前已接受过抗痉挛药和/或泻药治疗的中重度IBS-C成人患者，利那洛肽可能是一种具有成本效益的治疗方法。
