Yang Li, Chuen Tan Seng, Chen Can, Wang Xingzhi, Li Xinya, Yang Xiaoyan
Peking University Health Science Centre, Beijing, China.
IMS Health Asia Pacific, Singapore.
Clin Ther. 2016 Nov;38(11):2459-2467.e1. doi: 10.1016/j.clinthera.2016.09.012. Epub 2016 Oct 15.
To conduct a cost-effectiveness analysis study of sevelamer versus calcium-based binders (CBBs) in treating hyperphosphatemia among patients with end-stage renal disease (ESRD) in China.
A decision-analytic model of a lifetime horizon was used for base case analysis from the payers' perspective. The transition probabilities between different health states were derived from survival analysis. The overall survival of CBBs was derived from the Dialysis Clinical Outcomes Revisited study for up to 44 months and a Weibull regression model was used to extrapolate the overall survival to a lifetime horizon. A hazard ratio (0.54; 95% CI, 0.32-0.93) of the overall survival for sevelamer versus CBBs was used to calculate the survival of the sevelamer group. Clinical and cost data were derived from literature and health care system in the local setting. Incremental life year and quality-adjusted life year (QALY) were the primary outcomes. One-way and probabilistic sensitivity analyses were conducted to assess the uncertainty of the model assumptions and parameters. The results were reported in 2015 Chinese Renminbi.
The incremental cost per life year and per QALY gained of sevelamer versus CBBs was ¥44,475 and ¥57,910, respectively. The incremental cost per QALY gained was below the World Health Organization's recommended cost-effectiveness threshold (¥151,070), which is 3 times the gross domestic product per capita of 2015 in China. The incremental cost-effectiveness ratio was most sensitive to the hazard ratio of overall survival with sevelamer versus CBBs in the 1-way sensitivity analysis. The cost-effectiveness acceptability curve indicated that sevelamer had a 89.6% likelihood of cost-effectiveness at the ¥151,070 threshold.
Sevelamer is likely to be a cost-effective option in treating hyperphosphatemia among patients with ESRD compared with CBBs in the local context of China.
在中国开展一项关于司维拉姆与钙基结合剂（CBBs）治疗终末期肾病（ESRD）患者高磷血症的成本效益分析研究。
从支付方的角度，使用一个终生视角的决策分析模型进行基线分析。不同健康状态之间的转移概率来自生存分析。CBBs的总生存率来自“透析临床结局再探讨”研究，最长达44个月，并使用威布尔回归模型将总生存率外推至终生视角。司维拉姆与CBBs总生存率的风险比（0.54；95%可信区间，0.32 - 0.93）用于计算司维拉姆组的生存率。临床和成本数据来自当地的文献和医疗保健系统。增量生命年和质量调整生命年（QALY）是主要结局。进行单向和概率敏感性分析以评估模型假设和参数的不确定性。结果以2015年人民币报告。
司维拉姆相对于CBBs每获得一个生命年和每获得一个QALY的增量成本分别为44475元和57910元。每获得一个QALY的增量成本低于世界卫生组织推荐的成本效益阈值（151070元），该阈值是中国2015年人均国内生产总值的3倍。在单向敏感性分析中，增量成本效益比对司维拉姆与CBBs总生存率的风险比最为敏感。成本效益可接受性曲线表明，在151070元的阈值下，司维拉姆具有成本效益的可能性为89.6%。
在中国当地背景下，与CBBs相比，司维拉姆在治疗ESRD患者高磷血症方面可能是一种具有成本效益的选择。
