一个关于药物拟经济学的分析模型的Case study.pptVIP

Development of an Economic Model to Assess the Cost Effectiveness of Asthma Management Strategies Martin J.Price 1 and Andrew H.Briggs2 1 Global health outcomes, GlaxoSmithKline Research Development, Greenford, Middlesex, United Kingdom 2 Health Economics Research Centre, University of Oxford, Oxford, United Kingdom Pharmaceconomics 2002;20(3):183-194 Disease Disease:Asthma 慢性发作性疾病 急性症候（不同严重程度）性发作：wheeze, chest tightness, breathlessness, cough, nacturnal waking Treatment: A:salmeterol/flucticasone propionate combination(SFC,沙美特罗/丙酸氟替卡松联合给药)50/100µg B:flucticasone propionate(FP,丙酸氟替卡松)100µg 实验条件：一天两次，吸入式给药，持续12周，随机， 双盲的临床实验 Treatment success： Asthma control（defined in world-wide asthma management guidelines and in terms of QALYs） Results： 1, Effectiveness:Proportion of successfully controlled weeks per patient: SFC(66%)FP(47%) 2,Cost:Mean weekly direct asthma management cost: SFC(￡15.77)FP(￡11.83) 3, Average incremental cost per successfully controlled week with SFC:￡20.83 4,PSA(probabilistic sensitivity analysis):ICER(95% uncertainty intervals):- ￡ 64.94 to ￡ 112.66 if decision maker WTP ￡45 for an additional successful controlled week, SFC more cost-effective in 80% of the time Methods：Markov model Health states： 1,Successful control: table I 2,Hospital-managed exacerbation: hospital 3,Primary-care-managed exacerbation: outpatient 4,Sub-optimal control: between “successful control “ and “exacerbation” 5,Treatment failure : discontinue the study treatment Cycle length:1 week Transition parameters: figure I Health states： 1,Successful control: table I, well-controlled 代替total control,原因：1，对于一部分病人，不清楚total control 是否是现实的和可以达到的。2，对于某些决策者来说， 2,Hospital-managed exacerbati