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质子抑制剂比具有竞争力的酸阻断剂更具成本效益,用于胃食道逆流性疾病
Kate L Karlin1, Ella H Gilbert2, Francesca Lim3
1Division of Gastroenterology, University of Pennsylvania, Philadelphia, PA.
质子抑制剂 (PPI) 在治疗胃食道逆流症 (GERD) 方面比竞争性酸阻断剂 (PCAB) 更具成本效益. 虽然PCAB显示出有效性,但其较高的成本使PPI成为基于当前支付意愿值的首选初始治疗策略.
科学领域:
- 胃肠病学 胃肠病学
- 卫生经济学 卫生经济学
- 药物经济学 药物经济学
背景情况:
- 竞争性酸阻断剂 (PCABs) 为严重侵蚀性食道炎提供了优越的治疗方法,并已被批准用于非侵蚀性胃食道逆流症 (GERD).
- PCAB在为GERD患者实现无日方面表现出很高的有效性.
- 与质子抑制剂 (PPI) 相比,PCAB的采购成本较高,因此需要对GERD管理的成本效益进行评估.
研究的目的:
- 估计PCAB与PPI相比的成本效益,用于管理GERD.
- 评估不同GERD表型的成本效益,包括非侵蚀性GERD和侵蚀性食道炎的各个阶段.
- 确定影响PCAB与PPI成本效益的关键参数.
主要方法:
- 建立了一个决策树模型来比较PCAB和PPI作为GERD的第一线治疗.
- 场景包括非侵蚀性GERD,洛杉矶 (LA) A/B级和洛杉矶C/D级侵蚀性食道炎.
- 从社会角度来看,与质量调整的寿命年 (QALYs) 和成本进行了比较,使用6个月后100,000美元/QALY的支付意愿 (WTP) 门.
主要成果:
- PCAB与144,208美元/QALY的增量成本效益比率 (ICER) 相关,超过了100,000美元/QALY的WTP值.
- 成本差异有利于PPI,为3,240美元.
- 概率灵敏度分析表明,PPI在71.7%的代中受到青,PCAB成本和有效性是最有影响力的因素.
结论:
- 尽管证明了有效性,但与PCAB相比,PPI代表了用于初始GERD治疗的更具成本效益的策略.
- 如果每周成本降至91美元以下或接受更高的WTP门,PCAB可能会变得具有成本效益.
- 目前的证据支持使用PPI作为首选的第一线治疗GERD基于成本效益考虑.
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