公平的价格,公平的获取;对发展中国家新型高脂血症注射药物的成本效益进行系统审查
Samad Azari1, Hamid Pourasghari2, Mohammad Ali Rezaei2
1Hospital Management Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran. Samadazari1010@gmail.com.
Cost effectiveness and resource allocation : C/E
|November 22, 2025
概括
新的降脂疗法,如PCSK9抑制剂,在发展中国家往往无法负担得起. 埃沃洛库马布在特定高风险群体和国家表现出成本效益,而埃泽蒂米布在特定高风险群体和国家表现出成本效益,而埃泽蒂米布在特定高风险群体和国家表现出成本效益,而埃泽蒂米布在特定高风险群体和国家表现出成本效益,而埃泽蒂米布在特定高风险群体和国家表现出成本效益. 价格调整对于更广泛的访问至关重要.
科学领域:
- 心血管疾病管理管理
- 卫生经济学 卫生经济学
- 药物经济学 药物经济学
背景情况:
- 降脂疗法对于治疗心血管疾病至关重要.
- 蛋白转化酶潜素/素9型 (PCSK9) 抑制剂 (alirocumab,evolocumab) 和inclisiran提供优越的低密度脂蛋白胆固醇 (LDL-C) 降低.
- 新型疗法的高成本在低收入和中等收入国家带来了负担能力挑战.
研究的目的:
- 在发展中国家审查PCSK9抑制剂和inclisiran的成本效益.
- 为了比较新的降脂药物的经济价值与现有的治疗方法,如ezetimibe.
- 确定影响这些疗法的成本效益的因素,在不同的医疗保健环境.
主要方法:
- 在主要数据库 (PubMed,Scopus,Web of Science,Embase,CENTRAL) 进行系统的文献搜索,截至2024年3月1日.
- 包括来自发展中国家的13项研究,评估质量调整后寿命年 (QALY),增加寿命年 (LYG) 和增量成本效益比率 (ICER).
- 使用CHEERS和ECOBIAS检查清单评估研究质量和偏见,遵守PRISMA指南.
主要成果:
- 埃沃洛库马布显示了可变的成本效益:在中国 (价值281,762美元/QALY) 没有成本效益,但在家族性高胆固醇血症 (价值57,018美元/QALY) 和特定急性设置 (价值4,268美元-61,242美元/QALY) 中有利.
- 阿利罗库马布 (490,198美元/QALY) 和英克利西兰 (335,404.88美元/QALY) 通常不具有成本效益;埃泽蒂米布 (22,965美元/QALY) 更有利.
- 埃沃洛库马布在墨西哥 (37,925美元-44,346美元/卡里) 和沙特阿拉伯 (49,502美元-71,968美元/卡里) 具有成本效益,但在泰国和卡塔尔没有. 药物价格和支付意愿的门是关键因素.
结论:
- PCSK9抑制剂和inclisiran的成本效益在发展中国家之间有很大的差异.
- 埃沃洛库马布在高风险小组或在墨西哥和沙特阿拉伯等特定市场可能是可行的;埃泽蒂米布仍然是一个更稳定的负担得起的选择.
- 降价,分层定价和聚合采购等策略对于提高先进的降脂疗法的获取和公平性至关重要.
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