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在中国大陆,英克西兰与他汀类药物联合使用和单独使用他汀类药物治疗血脂异常的成本效益分析。

The combination use of inclisiran and statins versus statins alone in the treatment of dyslipidemia in mainland China: a cost-effectiveness analysis.

作者信息

Zhou Wenjing, Liang Zhuoru, Lou Xiaohuan, Wang Nansong, Liu Xinyu, Li Ruoxi, Pai Pearl

机构信息

The University of Hongkong-Shenzhen Hospital, Shenzhen, Guangdong, China.

The Third Affiliated Hospital (The Affiliated Luohu Hospital) of Shenzhen University, Shenzhen, Guangdong, China.

出版信息

Front Pharmacol. 2024 Feb 26;15:1283922. doi: 10.3389/fphar.2024.1283922. eCollection 2024.

Abstract

Statin is well-established as a classical lipid-lowering drug, and its cost has reduced considerably in the past years. Inclisiran is a new and effective lipid-lowering drug given as a subcutaneous injection at 6-month intervals. This study aims to evaluate the cost-effectiveness of the combination use of inclisiran and statin versus statin alone for dyslipidemia in the mainland China population. The Markov decision-making model was used, and the clinical data and real-world data were collected at the University of Hong Kong-Shenzhen Hospital (HKU-SZH). Patients with cardiovascular disease (CVD) and blood lipid levels above the target on statin therapy were included as the target population and analyzed for cardiovascular events, future medical expenses, and the calculation made for the total life cost, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs). Sensitivity analysis was conducted to evaluate the influence of parameter uncertainty on the base-case analysis results. If inclisiran was priced at Chinese renminbi (RMB) 20,000.00 (USD 2,973.49) per injection, patients in the inclisiran and statin group would incur an incremental cost of RMB 449,233.56 (USD 66,789.60) compared with the statin group, and they would obtain 0.21 more QALYs in their life cycle. The subsequent ICER of RMB 2,127,756.78 (USD 316,343.32)/QALY was significantly higher than the willingness-to-pay (WTP) threshold of 3 times the GDP of China, which was RMB 257,094.00 (USD 38,223.33)/QALY, suggesting that the combined use of inclisiran and statin was not cost-effective. If the price of inclisiran were reduced to RMB 2,500.00 (USD 371.69)/injection, the ICER of patients in the inclisiran and statin group would become RMB 257,790.63 (USD 38,326.91)/QALY, which is slightly lower than the WTP threshold of 3 times the GDP of China, indicating that the combined use of inclisiran and statin would be cost-effective. If inclisiran is priced at RMB 20,000.00 (USD 2,973.49)/injection, then the combined use of inclisiran and statins is not cost-effective compared with statin alone. It will be economical only if the price of inclisiran is reduced by more than 88%.

摘要

他汀类药物作为经典的降脂药物已被广泛认可,且在过去几年其成本大幅降低。英克西兰是一种新型有效的降脂药物,通过皮下注射给药,给药间隔为6个月。本研究旨在评估在中国内地人群中,英克西兰与他汀类药物联合使用相较于单独使用他汀类药物治疗血脂异常的成本效益。采用马尔可夫决策模型,并在香港大学深圳医院(HKU-SZH)收集临床数据和真实世界数据。将患有心血管疾病(CVD)且在他汀类药物治疗后血脂水平仍高于目标值的患者纳入目标人群,分析心血管事件、未来医疗费用,并计算总生命成本、质量调整生命年(QALY)和增量成本效益比(ICER)。进行敏感性分析以评估参数不确定性对基础病例分析结果的影响。如果英克西兰每针定价为人民币20,000.00元(2,973.49美元),与他汀类药物组相比,英克西兰与他汀类药物联合使用组的患者将产生449,233.56元人民币(66,789.60美元)的增量成本,且他们在生命周期内将多获得0.21个QALY。随后的ICER为2,127,756.78元人民币(316,343.32美元)/QALY,显著高于中国GDP的3倍的支付意愿(WTP)阈值,即257,094.00元人民币(38,223.33美元)/QALY,这表明英克西兰与他汀类药物联合使用不具有成本效益。如果英克西兰的价格降至每针2,500.00元人民币(371.69美元),英克西兰与他汀类药物联合使用组患者的ICER将变为257,790.63元人民币(38,326.91美元)/QALY,略低于中国GDP的3倍的WTP阈值,这表明英克西兰与他汀类药物联合使用将具有成本效益。如果英克西兰定价为每针20,000.00元人民币(2,973.49美元),那么与单独使用他汀类药物相比,英克西兰与他汀类药物联合使用不具有成本效益。只有当英克西兰的价格降低超过88%时才具有经济性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/93fd/10925700/a923cad0cf41/fphar-15-1283922-g001.jpg

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