Tilden Dominic, Guarnieri Carmel
Thema Consulting Pty Ltd., Pyrmont, New South Wales, Australia.
Thema Consulting Pty Ltd., Pyrmont, New South Wales, Australia.
Value Health. 2016 Mar-Apr;19(2):145-52. doi: 10.1016/j.jval.2015.11.009. Epub 2015 Dec 29.
Incobotulinumtoxin-A (Xeomin(®), Merz Pharmaceuticals, Sydney, New South Wales) is a formulation of botulinum neurotoxin type A that is free of complexing proteins.
To assess the cost-effectiveness of incobotulinumtoxin-A administered with flexible treatment intervals compared to onabotulinumtoxin-A (Botox(®), Sydney, New South Wales) in blepharospasm and cervical dystonia from the perspective of Australian health care providers.
A Markov state transition model was developed to perform a cost-utility analysis to compare the cost and health benefits of incobotulinumtoxin-A to that of onabotulinumtoxin-A. The cost-utility analysis compared incobotulinumtoxin-A treatment, given at minimum intervals of 6 weeks and maximum intervals of 20 weeks, with onabotulinumtoxin-A treatment, given at minimum intervals of 12 weeks and maximum intervals of 20 weeks. The Markov model consisted of three health states and followed patients in weekly cycles for 5 years. Only direct health care costs associated with the acquisition and administration of type A botulinum neurotoxins were included. Utility values were derived from a prospective, open-labeled cohort study. The primary outcome measure was the incremental cost per quality-adjusted life-year. Univariate and probabilistic sensitivity analyses were conducted.
Incobotulinumtoxin-A was cost-effective compared to onabotulinumtoxin-A in both blepharospasm and cervical dystonia, with an incremental cost/quality-adjusted life-year gained of A$ 25,588 and A$ 23,794, respectively.
Incobotulinumtoxin-A administered at flexible treatment intervals determined by the needs of the patient was found to be a cost-effective treatment option when compared to the administration of onabotulinumtoxin-A in the Australian health care system. The option to administer incobotulinumtoxin-A according to the needs of the patient resulted in patients experiencing symptoms for a fewer number of weeks compared to onabotulinumtoxin-A given at minimum 12-week intervals.
因可肉毒毒素A（Xeomin(®)，默克制药公司，悉尼，新南威尔士州）是一种不含复合蛋白的A型肉毒神经毒素制剂。
从澳大利亚医疗服务提供者的角度评估与注射用A型肉毒毒素（Botox(®)，悉尼，新南威尔士州）相比，灵活调整治疗间隔使用因可肉毒毒素A治疗眼睑痉挛和颈部肌张力障碍的成本效益。
建立马尔可夫状态转移模型进行成本效用分析，比较因可肉毒毒素A与注射用A型肉毒毒素的成本和健康效益。成本效用分析比较了因可肉毒毒素A（最小间隔6周，最大间隔20周给药）与注射用A型肉毒毒素（最小间隔12周，最大间隔20周给药）。马尔可夫模型包含三种健康状态，以每周为周期跟踪患者5年。仅纳入与A型肉毒神经毒素获取和给药相关的直接医疗成本。效用值来自一项前瞻性、开放标签队列研究。主要结局指标是每质量调整生命年的增量成本。进行了单因素和概率敏感性分析。
在眼睑痉挛和颈部肌张力障碍治疗中，与注射用A型肉毒毒素相比，因可肉毒毒素A具有成本效益，每获得一个质量调整生命年的增量成本分别为25588澳元和23794澳元。
在澳大利亚医疗体系中，根据患者需求灵活调整治疗间隔使用因可肉毒毒素A与使用注射用A型肉毒毒素相比是一种具有成本效益的治疗选择。与至少每12周给药一次的注射用A型肉毒毒素相比，根据患者需求使用因可肉毒毒素A可使患者出现症状的周数减少。
