West China School of Pharmacy, Sichuan University, 17 Renmin South Road (3Rd Section), Chengdu, 610041, China.
Division of Biomedical Informatics, National University of Singapore, Singapore, Singapore.
J Orthop Surg Res. 2024 Aug 18;19(1):491. doi: 10.1186/s13018-024-04973-9.
This study aimed to evaluate the long-term cost-effectiveness of conventional care (CC) and seven first-line targeted therapies marketed in China for the treatment of patients with ankylosing spondylitis (AS)-namely secukinumab, ixekizumab, infliximab, etanercept, adalimumab and golimumab and tofacitinib-from the perspective of the Chinese health care system.
The York model was structured as a 12-week decision tree leading into two Markov models. This study set 1 year as a recurring cycle and a lifetime timeframe for the model. Primary model outcomes included the costs in Chinese yuan (CNY), health outcomes in quality-adjusted life-years (QALYs) and the incremental cost-effectiveness ratio (ICER) under a willingness-to-pay threshold of ¥89,358 (equal to the per capita gross domestic product in China in 2023) per QALY. Parameters in the York model were captured from network meta-analyses and literature including treatment response, short-term disease progression, patient functioning and long-term structural disease progression. Utilities are dependent on indicators such as the BASDAI score, the BASFI score, gender and age. Drug prices were analysed using the median price of the Chinese market from YAOZH net in the basic analysis. Costs and outcomes were discounted at 5.0%. We performed deterministic and probabilistic sensitivity analyses to investigate the robustness of the results. The prices of original drugs and generic drugs were used in the scenario analysis.
Compared with CC, the ICER of golimumab was ¥104,217.4/QALY, which is between 1 and 3 times the GDP per capita, while the ICERs of the other six targeted therapies were less than ¥89,358/QALY. The specific economic rank of the targeted therapy was as follows: secukinumab > ixekizumab > tofacitinib > infliximab > etanercept > adalimumab > golimumab. Treatment response rates such as the BASDAI50, changes in the BASDAI/BASFI scores and the discounting rate were key model drivers. According to the scenario analysis, IL-17 inhibitors were still the most economical intervention when original drugs and generic drugs were used.
Targeted therapies are cost-effective treatments for AS. Overall, IL-17 inhibitors were the dominant treatment. The choice of the brand-new prices or generic drug prices can greatly affect economics.
本研究旨在评估在中国用于治疗强直性脊柱炎（AS）患者的常规治疗（CC）和七种一线靶向治疗药物（依奇珠单抗、司库奇尤单抗、英夫利昔单抗、依那西普、阿达木单抗、戈利木单抗和托法替布）的长期成本效益，从中国医疗保健系统的角度来看。
约克模型构建为一个 12 周的决策树，然后进入两个马尔可夫模型。本研究将 1 年作为一个重复周期和一个终生时间框架。模型的主要结果包括中国人民币（CNY）成本、质量调整生命年（QALYs）健康结果和意愿支付阈值为 89358 元（相当于 2023 年中国人均国内生产总值）每 QALY 的增量成本效益比（ICER）。约克模型中的参数来自网络荟萃分析和文献，包括治疗反应、短期疾病进展、患者功能和长期结构疾病进展。效用取决于 BASDAI 评分、BASFI 评分、性别和年龄等指标。药物价格在基本分析中使用 YAOZH 网的中国市场中位数价格进行分析。成本和结果以 5.0%贴现。我们进行了确定性和概率敏感性分析，以调查结果的稳健性。原药和仿制药的价格用于情景分析。
与 CC 相比，戈利木单抗的 ICER 为 104217.4 元/QALY，介于 1 至 3 倍人均 GDP 之间，而其他六种靶向治疗药物的 ICER 低于 89358 元/QALY。靶向治疗的具体经济排名如下：司库奇尤单抗>依奇珠单抗>托法替布>英夫利昔单抗>依那西普>阿达木单抗>戈利木单抗。治疗反应率（如 BASDAI50）、BASDAI/BASFI 评分变化和贴现率是模型的关键驱动因素。根据情景分析，当使用原药和仿制药时，IL-17 抑制剂仍然是最经济的干预措施。
靶向治疗是治疗 AS 的一种具有成本效益的方法。总体而言，IL-17 抑制剂是主要的治疗方法。全新价格或仿制药价格的选择会极大地影响经济学。
