Department of Gastroenterology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
Changsha Normin Health Technology Ltd, Changsha, China.
Adv Ther. 2020 Jan;37(1):431-449. doi: 10.1007/s12325-019-01150-x. Epub 2019 Dec 3.
To assess the cost-effectiveness of reimbursing infliximab for moderate-to-severe Crohn's disease (MS-CD) in China from the perspective of public insurance payers.
A decision-analytic model with a lifetime time horizon was constructed to simulate the disease progression and direct medical costs in Chinese MS-CD patients under two scenarios: reimbursing infliximab vs. not reimbursing infliximab. A cross-sectional study and literature review were conducted to estimate model variables. The constructed decision-analytic model ran the base case, one-way sensitivity, and probabilistic sensitivity analyses (PSA) to assess the cost-effectiveness of reimbursing infliximab using reimbursed medical costs.
Base case analysis discounting health benefits and costs estimated that reimbursing infliximab could increase overall survival by 0.604 years, increase total quality-adjusted life years (QALY) by 0.697 QALY, reduce absolute lifetime surgery risk by 13.1%, and increase reimbursed costs by ¥29,409. The incremental cost-effectiveness ratio per gained additional QALY (ICER) based on discounted health benefits and reimbursed medical costs (3% per year) was ¥42,198. The one-way sensitivity analyses identified that the cost-effectiveness of reimbursing infliximab for MS-CD was mainly driven by the treatment efficacies of maintenance therapy, quality of life, and unit price of infliximab. PSA estimated that reimbursing infliximab was associated with a 63.8% chance to be cost-effective under the willingness-to-pay of the 2018 Chinese gross domestic product per capita (GDPPC).
Reimbursing infliximab for MS-CD in Chinese patients was highly attractive, costing Chinese public insurance payers less than the 2018 Chinese GDPPC to gain 1 QALY.
从公共保险支付者的角度评估在中国为中度至重度克罗恩病（MS-CD）报销英夫利昔单抗的成本效益。
构建了一个具有终生时间范围的决策分析模型，以模拟两种情况下中国 MS-CD 患者的疾病进展和直接医疗费用：报销英夫利昔单抗与不报销英夫利昔单抗。进行了一项横断面研究和文献回顾，以估算模型变量。构建的决策分析模型进行了基础案例、单因素敏感性和概率敏感性分析（PSA），以使用报销的医疗费用评估报销英夫利昔单抗的成本效益。
基础案例分析不考虑健康效益和成本，估计报销英夫利昔单抗可使总生存期延长 0.604 年，增加总质量调整生命年（QALY）0.697 QALY，降低绝对终生手术风险 13.1%，并增加报销费用 29409 元。基于折扣健康效益和报销医疗费用（每年 3%）的每获得额外 QALY 的增量成本效益比（ICER）为 42198 元。单因素敏感性分析确定，报销英夫利昔单抗治疗 MS-CD 的成本效益主要取决于维持治疗的疗效、生活质量和英夫利昔单抗的单价。PSA 估计，在 2018 年中国人均国内生产总值（GDPPC）的支付意愿下，报销英夫利昔单抗与 63.8%的可能性具有成本效益。
在中国患者中报销英夫利昔单抗治疗 MS-CD 非常有吸引力，报销英夫利昔单抗的费用低于 2018 年中国人均 GDPPC，每获得 1 个 QALY。
