艾拉莫德联合甲氨蝶呤用于单药治疗失败的活动性类风湿关节炎患者的成本-效用分析 点击下载
| 论文标题： | 艾拉莫德联合甲氨蝶呤用于单药治疗失败的活动性类风湿关节炎患者的成本-效用分析 |
| 英文标题： | |
| 中文摘要： | 目的 评估艾拉莫德联合甲氨蝶呤用于传统合成改善病情抗风湿药（csDMARDs）单药治疗失败的活动性类风湿关节炎（RA）患者的经济性。方法采用成本-效用分析法，基于中国医疗卫生体系视角构建马尔可夫模型，模型周期为6个月，模拟治疗30年后艾拉莫德联合甲氨蝶呤对比不同csDMARDs联合方案的成本和健康[质量调整生命年（QALYs）]产出。其中，有效性和安全性数据通过网状Meta分析整合随机对照试验数据获得，成本参数来自米内网数据库和已发表文献等，折现率为4.5%，意愿支付（WTP）阈值为2025年我国人均国内生产总值的2倍（199330.00元/QALY）。通过单因素敏感性分析、概率敏感性分析和情境分析检验结果的稳健性。结果与甲氨蝶呤+柳氮磺吡啶、柳氮磺吡啶+来氟米特方案相比，艾拉莫德+甲氨蝶呤方案为绝对优势方案；与甲氨蝶呤+来氟米特相比，艾拉莫德+甲氨蝶呤的增量成本-效果比为60577.10元/QALY，小于WTP阈值。敏感性分析和情境分析结果表明上述结果的稳健性较好。结论在中国医疗卫生体系下，相比甲氨蝶呤+来氟米特、甲氨蝶呤+柳氮磺吡啶和柳氮磺吡啶+来氟米特方案，艾拉莫德+甲氨蝶呤用于csDMARDs单药治疗失败的活动性RA患者具有经济性。 |
| 英文摘要： | OBJECTIVE To evaluate the cost-utility of iguratimod combined with methotrexate in the treatment of patients with active rheumatoid arthritis （RA） who failed monotherapy with conventional synthetic disease-modifying antirheumatic drugs （csDMARDs）.METHODS A cost-utility analysis was performed. A Markov model was constructed from the perspective of China’s healthcare system with a cycle length of 6 months to simulate the costs and health outcomes [quality-adjusted life years （QALYs）] of iguratimod combined with methotrexate versus different combined csDMARDs regimens over a 30-year time horizon. Efficacy and safety data were synthesized from randomized controlled trials via network meta-analysis. Cost parameters were derived from the Menet Database， published literature and other sources. The discount rate was set at 4.5%， and the willingness-to-pay （WTP） threshold was twice China’s per capita gross domestic product in 2025 （199 330.00 yuan/QALY）. One-way sensitivity analysis， probabilistic sensitivity analysis and scenario analysis were conducted to verify the robustness of the results.RESULTS Compared with methotrexate+sulfasalazine and sulfasalazine+leflunomide， iguratimod+methotrexate was a dominant regimen. Compared with methotrexate+leflunomide， the incremental cost-effectiveness ratio of iguratimod+methotrexate was 60 577.10 yuan/QALY， which was lower than the WTP threshold. Sensitivity analyses and scenario analysis confirmed favorable robustness of the above findings.CONCLUSIONS From the perspective of China’s healthcare system， iguratimod+methotrexate is cost-effective for active RA patients failing csDMARD monotherapy， in comparison with methotrexate+leflunomide， methotrexate+sulfasalazine and sulfasalazine+leflunomide regimens. |
| 期刊： | 2026年第37卷第16期 |
| 作者： | 龚小玲；颜建周；董心月；赖永全 |
| 英文作者： | GONG Xiaoling，YAN Jianzhou，DONG Xinyue，LAI Yongquan |
| 关键字： | 艾拉莫德；传统合成改善病情抗风湿药；类风湿关节炎；甲氨蝶呤；联合疗法；药物经济学；马尔可夫模型 |
| KEYWORDS： | Iguratimod;conventional synthetic disease-modifying antirheumatic drugs;Rheumatoid arthritis;Methotrexate;combination therapy;Pharmacoeconomics;Markov model |
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