School of Public Health, Fudan University, Shanghai, 200032, China.
NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, 200032, China.
Adv Ther. 2022 Jun;39(6):2971-2983. doi: 10.1007/s12325-022-02161-x. Epub 2022 Apr 30.
Linaclotide, a selective agonist of guanylate cyclase C, was highly recommended for the treatment of irritable bowel syndrome with constipation (IBS-C). However, the cost-effectiveness of linaclotide in Chinese is not known, and this study aimed to assess the cost-effectiveness of linaclotide for patients with IBS-C.
An economic evaluation was conducted with a Markov model from a societal perspective. The Markov model was structured to simulate the discontinuation and continuation of medication in IBS-C patients in clinical practice, as well as the revisit and non-visit of non-responding patients. The cycle of the model was 4 weeks, and the time horizon was 1 year. The efficacy data in the model was from the risk ratios obtained by the meta-analysis and the calculation of the response rate of the three medications. The utility, discontinuation rate of the medication, and revisit rate data were from published literature, while the cost data were obtained from experts' opinions and published literature. A series of sensitivity analyses was performed on parameters potentially having impact on the model outputs.
The QALYs (quality-adjusted life years) gained for 1-year treatment with linaclotide, polyethylene glycol, and lactulose were 0.821, 0.795, and 0.781, respectively. The corresponding total costs were CNY 7,721 (USD 1,120), CNY 8,797 (USD 1,276) and CNY 9,481 (USD 1,375). In both comparisons, linaclotide was dominant. Compared with polyethylene glycol and lactulose, the likelihood of linaclotide being cost-effective was 100% for both, using 1 times per capita GDP per QALY as willingness-to-pay threshold.
IBS-C seriously affects the quality of life of patients with IBS-C, and linaclotide can improve symptoms and quality of life at less cost.
利那洛肽是一种鸟苷酸环化酶 C 的选择性激动剂，强烈推荐用于治疗便秘型肠易激综合征（IBS-C）。然而，利那洛肽在中国的成本效益尚不清楚，本研究旨在评估利那洛肽治疗 IBS-C 的成本效益。
采用Markov 模型从社会角度进行经济评价。该 Markov 模型用于模拟临床实践中 IBS-C 患者停药和继续用药、无应答患者就诊和不就诊的情况。模型的周期为 4 周，时间范围为 1 年。模型中的疗效数据来自荟萃分析获得的风险比和三种药物的应答率计算结果。效用、药物停药率和就诊率数据来自已发表的文献，而成本数据则来自专家意见和已发表的文献。对可能影响模型输出的参数进行了一系列敏感性分析。
利那洛肽、聚乙二醇和乳果糖治疗 1 年的 QALYs（质量调整生命年）分别为 0.821、0.795 和 0.781。相应的总费用分别为人民币 7721 元（1120 美元）、人民币 8797 元（1276 美元）和人民币 9481 元（1375 美元）。在这两种比较中，利那洛肽均为优势方案。与聚乙二醇和乳果糖相比，以人均 GDP 的 1 倍作为意愿支付阈值，利那洛肽的成本效益比为 100%。
IBS-C 严重影响 IBS-C 患者的生活质量，利那洛肽可以以较低的成本改善症状和生活质量。
