Sun Xueshan, Zhen Xuemei, Hu Xiaoqian, Li Yuanyuan, Gu Shuyan, Gu Yuxuan, Zhao Zixuan, Yang Wei, Dong Hengjin
Center for Health Policy Studies, School of Public Health, Zhejiang University School of Medicine, Hangzhou, China.
School of Health Care Management, Shandong University, Jinan, China.
Ann Transl Med. 2021 Apr;9(7):575. doi: 10.21037/atm-21-290.
The objective of this study is to compare the long-term cost-utility of imrecoxib and celecoxib for patients with osteoarthritis (OA) from the perspective of the Chinese healthcare system.
An economic model was built based on the model from the National Institute for Health and Care Excellence (NICE). The simulation was carried out initially for 100 cycles of 3 months each, starting with 10,000 patients. A discount rate of 5% was applied both for cost and utility. Quality-adjusted life years (QALYs) were adopted as the utility indicator, and real-world data from the hospital information systems of 170 hospitals was collected to indicate cost. The relative incidence rates of adverse events (AEs) with imrecoxib and celecoxib were collected from randomized controlled trials. Sensitivity analysis was performed to validate the robustness of the model.
In the base case analysis (6-month treatment duration, 55 years old and above), imrecoxib was the more cost-effective option compared to celecoxib, with an incremental cost-effectiveness ratio (ICER) of $3,041.14. This finding remained unchanged after varying the treatment duration and the age of the patients. The main drivers of the results were the relative incidence of myocardial infarction (MI), the cost of imrecoxib, and the utility of OA patients without any AEs. Probability sensitivity analysis (PSA) showed that there was a 59.02% probability of imrecoxib as the more cost-effective option, with a threshold of $30,000.
Although there were uncertainties, imrecoxib was the more cost-effective option compared to celecoxib, with a definite possibility. Due to the limitations of the original model and this study, the results of this study should be adopted with caution.
本研究的目的是从中国医疗保健系统的角度比较艾瑞昔布和塞来昔布治疗骨关节炎（OA）患者的长期成本效益。
基于英国国家卫生与临床优化研究所（NICE）的模型构建了一个经济模型。最初以10,000名患者为起点，进行为期100个周期、每个周期3个月的模拟。成本和效用均采用5%的贴现率。采用质量调整生命年（QALYs）作为效用指标，并收集了170家医院信息系统的真实世界数据以表明成本。从随机对照试验中收集了艾瑞昔布和塞来昔布不良事件（AE）的相对发生率。进行敏感性分析以验证模型的稳健性。
在基础病例分析（治疗持续时间6个月，年龄55岁及以上）中，与塞来昔布相比，艾瑞昔布是更具成本效益的选择，增量成本效益比（ICER）为3,041.14美元。在改变治疗持续时间和患者年龄后，这一发现保持不变。结果的主要驱动因素是心肌梗死（MI）的相对发生率、艾瑞昔布的成本以及无任何AE的OA患者的效用。概率敏感性分析（PSA）表明，艾瑞昔布作为更具成本效益选择的概率为59.02%，阈值为30,000美元。
尽管存在不确定性，但艾瑞昔布与塞来昔布相比，明确有可能是更具成本效益的选择。由于原始模型和本研究的局限性，本研究结果应谨慎采用。
