摘要
目的基于社会角度,通过成本-效果分析(CEA)和成本-效用分析(CUA),评价目前临床常用治疗人乳头瘤病毒(HPV)感染药物重组人干扰素α2b凝胶(尤靖安)、保妇康栓以及非药物治疗对HPV清除率的经济学优劣。方法采用流行病学队列研究设计,前瞻性收集真实临床环境下2015年6月至2017年8月来自北京、重庆、陕西、贵州、浙江、河北、山西等17家医院1138例慢性宫颈炎合并高危HPV阳性门诊患者的临床诊疗信息、用药信息、生命质量、成本信息,分别采用高危HPV清除率和质量调整生命年(QALYs)作为效果和效用指标,采用决策树模型分别评价治疗后12个月内不同药物干预以及药物干预和非药物干预的成本-效果和成本-效用。结果治疗后3个月,尤靖安组、保妇康栓组和非药物治疗组高危HPV清除率分别为70.06%、57.65%和45.36%,差异有统计学意义(P<0.05);6个月时尤靖安组、保妇康栓组和非药物治疗组高危HPV清除率分别为87.58%、77.73%和68.70%,尤靖安组高于保妇康栓组,两药物治疗组均高于非药物干预组,差异有统计学意义(P<0.05);9个月、12个月时,3组患者的HPV清除率均达90%以上,3组HPV清除率比较差异无统计学意义(P>0.05)。治疗后12个月尤靖安组、保妇康栓组和非药物治疗组分别增加0.189 5、0.157 4和0.145 2个QALYs,与非药物治疗组比较,尤靖安组每多获得一个QALYs需多花费12 086.68元,保妇康栓组每多获得一个QALYs需多花费47 781.97元。结论药物治疗高危HPV感染与非药物治疗比较,能更快清除高危HPV,具有成本-效用优势;尤靖安组与保妇康栓组比较,清除高危HPV感染速度更快,具有一定的成本-效用优势。考虑到长期持续高危HPV感染与宫颈癌的关系,对于尤靖安来说,由于其能更快清除高危HPV,减少HPV持续感染时间,降低宫颈癌危险因素,因此尤靖安治疗高危HPV感染具有经济学优势。
Objective Based on social perspective, using cost-effectiveness analysis(CEA) and cost-utility analysis(CUA) to evaluate, to evaluate the economics of the current clinical treatment of human papillomavirus(HPV) infection drug recombinant human interferon α2 b gel(Yu Jingan), Baofukang suppository and non-pharmacological treatment on HPV clearance rate. Methods From June 2015 to August 2017, an epidemiological cohort study design was used to prospectively collect real clinical diagnosis and treatment information, medication information, quality of life, and cost information of 1138 patients with chronic cervicitis with high-risk HPV infection from 17 hospitals in Beijing, Chongqing, Shanxi, Guizhou, Zhejiang, Hebei and Shanxi etc.. High-risk HPV clearance and quality-adjusted life years(QALYs) were used as efficacy and utility indicators, respectively. Decision tree model was used to evaluate the cost-effectiveness and cost-utility of different drug interventions, drug interventions and non-drug interventions within 12 months after treatment. Results The clearance rates of high-risk HPV in 3 months after treatment were 70.06%, 57.65% and 45.36% respectively in Youjingan, Baofukang suppository and non-drug therapy group and in the 6 thmonth were 87.58%, 77.73%. and 68.70%. Youjingan group was higher than Baofukang suppository group. Both drug treatment groups were higher than the non-drug intervention group(P<0.05). By 9 th month and 12 th month, the clearance rates of high-risk HPV were more than 90% in all 3 groups(P>0.05). After the 12-month observation period, Youjingan, Baofukang suppository and non-drug therapy group increased by 0.189 5, 0.157 4 and 0.145 2 QALYs respectively. Compared with the non-drug therapy group, Youjinan group cost an additional 12 086.68 yuan for each additional quality-adjusted life year, and the Baofukang suppository group cost 47 781.97 yuan for for each additional QALYs. Conclusion Drug intervention can eliminate high-risk HPV more quickly than non-drug treatment, and has cost-effectiveness advantages. Compared with Baofukang suppository, Youjingan can eliminate high-risk HPV infection faster and has certain cost-effectiveness advantages. Considering the relationship between long-term persistent high-risk HPV infection and the cervical cancer, the Youjingan has the economic advantages in the treatment of high-risk HPV infection, because it can eliminate high-risk HPV more quickly, reduce the duration of HPV persistent infection and reduce the risk factors of cervical cancer.
作者
张学斌
管海静
刘国恩
ZHANG Xue-Bin;GUAN Hai-Jing;LIU Guo-En(Beijing Kangpite Medical Science and Technology Development Co.,Ltd.,Beijing 100101,China;China Center for Health and Economic Research,Peking University,Beijing 100871,China)
出处
《中国药物经济学》
2019年第10期28-37,共10页
China Journal of Pharmaceutical Economics
