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OBJECTIVE To evaluate the cost-effectiveness of clopidogrel versus aspirin monotherapy regimens for secondary prevention of ischemic stroke and to provide economic evidence and reference for clinical medication and decision-making. METHODS Based on the CAPRIE trial， a Markov model was constructed； the probabilities of risk events， health utility values， and costs of risk event management were obtained from relevant literature. The cycle length was 6 months， and the time horizon was 10 years. A discount rate of 5% per year was applied. The primary outcomes were total costs， quality-adjusted life-years （QALYs）， and incremental cost-effectiveness ratio （ICER）. Cost-utility analysis was performed for above 2 regimens by using TreeAge Pro software. The one-way sensitivity analysis， probabilistic sensitivity analysis and scenario analysis were conducted to validate the robustness of the analyses. RESULTS Compared with the aspirin regimen （325 mg/d of CAPRIE trial dose）， the ICER values of clopidogrel regimen for secondary stroke prevention for 10 years， 20 years and 30 years were 4 284.06， 4 201.20 and 3 986.78 yuan/QALY， respectively， which were E-mail：liuxiaoyanrj@sjtu.edu.cn all less than the willing-to-pay （WTP） threshold of one time 。 China’s per capita gross domestic product （GDP） in 2021. E-mail：scilwsjtu-wb@yahoo.com Compared with the aspirin regimen （clinically recommended dose in China， 100 mg/d）， the ICER values of clopidogrel regimen for stroke secondary prevention for 10 years， 20 years and 30 years were 58 238.27， 42 164.72 and 36 164.77 yuan/QALY， respectively， which were all less than WTP threshold. When comparing with aspirin regimen of 325 mg/d， results of one-way sensitivity analysis showed that the cost of clopidogrel and aspirin， probability of the first recurrence of ischemic stroke were sensitive factors of model. Results of probabilistic sensitivity analysis showed that when WTP was set at one time GDP per capita in China in 2021， clopidogrel had a probability of being cost- effective of about 66.5%. Results of scenario analysis showed that neither changing the time horizon to 10， 20 or 30 years nor using different doses of aspirin （50， 100， 150， 200 or 250 mg/d） would not alter any conclusions. CONCLUSIONS Compared with aspirin monotherapy， clopidogrel monotherapy is more cost-effective for secondary prevention of ischemic stroke.
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OBJECTIVE To evaluate the cost-utility of as-needed inhaled budesonide/formoterol versus budesonide maintenance therapy combined with as-needed inhaled terbutaline （hereinafter referred to as budesonide maintenance therapy） in patients with mild asthma from the perspective of the Chinese health service system. METHODS A Markov model of mild asthma was established based on an international multicenter randomized controlled clinical study （SYGMA 2 study）； the model cycle was one week， and the model had a whole horizon of 60 years. The cost only included direct medical cost， and utility value was derived from the data of EuroQol 5-Dimension 5-Level in the SYGMA 2 study and published literature. The total cost and total output of the above two inhalation therapies for patients with mild asthma were calculated， with discount rate of 5%. The stability of the model was evaluated by sensitivity analysis. RESULTS The total cost of as-needed inhaled budesonide/formoterol and budesonide maintenance therapy were 25 884 yuan and 45 822 yuan， respectively， and the effectiveness were 30.51 quality- adjusted life years （QALYs） and 30.50 QALYs， respectively. The former scheme was an absolute advantage. One-way sensitivity analyses showed that the price of drug （terbutaline and budesonide/formoterol） and average number of inhalations per day were the main influencing parameters， but they had little influence on the results of basic analysis. Probabilistic sensitivity analysis showed that the probability of as-needed budesonide/formoterol being cost-effective was 100%. CONCLUSIONS Compared with budesonide maintenance therapy， as-needed inhalation of budesonide/formoterol in mild asthma patients is more cost-effective.
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OBJECTIVE To eva luate the economy of loratinib versus crizo tinib in the first-line treatment of anaplastic lymphoma kinase （ALK）-positive advanced non-small cell lung cancer （NSCLC）from the perspective of China ’s health system ， and to provide reference for the product pricing and related medical decisions of the drug in other regions of China except for Hong Kong. METHODS Markov model and partition survival model both constructed based on the CROWN data （the simulation time limit was 10 years and the cycle period was 4 weeks）；the quality adjusted life year （QALY）was used as the outcome index to calculate the incremental cost-effectiveness ratio （ICER）. One-way sensitivity analysis ，probability sensitivity analysis and scenario analysis were used to verify the robustness of the results. RESULTS The basic analysis results based on Markov model showed that compared with crizotinib group ，the per capita cost of loratinib group increased by 17 867 588.63 yuan，the per capita utility increased by 1.76 QALYs，and the ICER was 10 152 038.99 yuan/QALY. The basic analysis results based on the partition survival model showed that compared with the crizotinib group ，the Δ 基金项目：江苏省博士后科研资助计划项目（No.2021K496C）； per capita cost of loratinib group increased by 18 009 592.54 2020年度高校哲学社会科学研究一般项目（No.2020SJA0070） yuan，the per capita utility increased by 1.74 QALYs，and the ＊硕士研究生 。研究方向 ：药物经济学 、卫生经济与政策 。 E-mail：sunlei_cpu@163.com ICER was 10 350 340.54 yuan/QALY. The results of one-way # 通信作者：教授，博士生导师。研究方向：药物经济学、卫生经 sensitivity analysis of the two models both showed that 济与政策。E-mail：ma86128@sina.com progression-free survival （PFS）state utility v alue，progression- ·1102· China Pharmacy 2022Vol. 33 No. 9 中国药房 2022年第33卷第9期 disease（PD）state utility value and loratinib cost had great influence on the results. The results of probability sensitivity analysis showed that when 1-3 times of China ’s per capita GDP in 2020 was taken as the willingness to pay threshold ，the probability of loratinib being economical was 0. The recommended unit price of loratinib per 100 mg was 657.10-815.60 yuan. CONCLUSIONS For patients with ALK-positive advanced NSCLC ，loratinib is more effective than crizotinib in the first-line treatment ，but it is not economical under the current price ；reasonably lowering the price of loratinib can increase the probability of its economy.
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OBJECTIVE：To evaluate the economy performance of dexamethasone （DXM）combined with rituximab （RTX） for the first-line treatment of chronic primary immune thrombocytopenia （ITP）in adults. METHODS ：From the perspective of China ’s medical and health system ，Markov model for eight states was constructed with a period of 4 weeks and a time limit of 20 years， using DXM regimen as control. The cost-utility of DXM+RTX regimen for the treatment of chronic ITP in adults were evaluated. The parameters of clinical efficacy and utility value were derived from own published literature ；cost parameters were from the MENET website and the official websites of local health committees and medical insurance bureaus ；one-way sensitivity analysis ， probability sensitivity analysis and scenario analysis were performed to observe the uncertainty of model and data source. RESULTS：The average cost of DXM+RTX regimen was 51 064 dollars and that of DXM regimen was 50 455 dollars. Compared with DXM regimen ，DXM+RTX regimen yielded an additional 0.14 QALYs for each patient ；the incremental cost-effectiveness ratio（ICER）was 4 356 dollars/QALY，and was lower than the willingness-to-pay threshold of China ’s per capita gross domestic product（GDP）in 2020. In the one-way sensitivity analysis ，the cost of drugs was the main driver in the model. Probability sensitivity analysis demonstrated that DXM+RTX regimen had 57.5％-61.0％ probability of being cost-effective at a willingness- to-pay threshold of 1-3 times per capita GDP in 2020. The results of scenario analysis showed that DXM+RTX regimen would have obvious long-term benefits ，and the utility value had little impact on the conclusion. CONCLUSIONS ：DXM + RTX is more economical than DXM in the treatment of chronic ITP in adults ，but the results have the uncertainty.
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OBJECTIVE：To review the method and results of pharmacoeconomic evaluation of aspirin for cardiovascular disease prevention ，and to provide reference for economic evaluation of aspirin and clinical medication decision. METHODS ： Using“cardiovascular disease ”“cost-effectiveness”“cost-utility”“cost-benefit”“cost effectiveness ”“cost utility ”as the Chinese search terms ，using“cost-effectiveness”“cost-utility”“cost-benefit”“economic analysis ”“pharmacoeconomics”as English search terms，relevant literatures about pharmacoeconomic evaluation of aspirin for cardiovascular disease prevention published during January 1，2000 to January 17，2021 were retrieved from CNKI ，Wanfang database ，VIP，PubMed，Web of Science ，the Cochrane Library. After screening literatures according to inclusion and exclusion criteria ，extracting relevant data ，the quality of included literatures was evaluated with CHEERS scale. The method and results of pharmacoeconomic evaluation of aspirin in the prevention of cardiovascular diseases were analyzed statistically in terms of basic information ，literature quality ，model structure and elements ，health status and utility value ，cost items and sources ，health output ，economic evaluation and sensitivity analysis. RESULTS & CONCLUSIONS ：Nine literatures were included ，and the total coincidence rates of the literatures were all above 80.00％. The pharmacoeconomic evaluation of aspirin in the prevention of cardiovascular disease mainly adopted Markov model ， and the model structure was relatively mature. The cost mainly considered the direct cost ，and the data mainly came from the medical insurance database ；utility was calculated according to the utility value of health state ，which mostly came from the existing literatures. The sensitivity analysis adopted deterministic sensitivity analysis and probabilistic sensitivity analysis ，and the main influential factor was cost. It was economical to use aspirin for cardiovascular disease prevention in most cases ，and aspirin was more economical for primary prevention of cardiovascular disease. It is suggested that domestic scholars can refer to China ’s pharmacoeconomic guidelines to carry out relvant pharmacoeconomic evaluation research more standardized.
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OBJECTIVE：To evaluate the economy of pe rospirone in the treatment of schizophrenia ，to provide guidance for clinically proper use of medications more cost-effectively ，and related health decision-making . METHODS ：A short-term decision tree model was constructed from the perspective of medical insurance payer to calculate the cost and health outcomes of different treatment plans considering major adverse events including extrapyramidal reaction ，weight gain ，diabetes，hyperlipidemia. The cost-utility of perospirone were compared with quetiapine ，aripiprazole and olanzapine respectively ，using QALYs as the measure of health outcomes ，3 times GDP per capita as the willingness-to-pay threshold ；probability sensitivity analysis was performed. RESULTS：The results of base-case analysis showed that the cost of perospirone （6 688.25 yuan）was lower than those of quetiapine （9 887.45 yuan），aripiprazole（13 284.65 yuan）and olanzapine （15 332.80 yuan）. The utility of perospirone （0.79 QALYs）was better than those of quetiapine （0.76 QALYs），aripiprazole（0.77 QALYs）and olanzapine （0.75 QALYs）. Compared with quetiapine ， aripiprazole and olanzapine ，peropirone had lower cost and higher health outcome ，which indicated that strong dominance favors perospirone over the other 3 drugs. The results of sensitivity analysis were consistent with those of base-case analysis. CONCLUSIONS：Perospirone has economic advantages in treating schizophrenia patients compared to other commonly used atypical antipsychotic drugs.
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OBJECTIVE：To evaluate the economics of first-line therapy drug for metastatic renal cell carcinoma （mRCC）as sunitinib，sorafenib and pazopanib ，and to provide reference for the adjustment of medical insurance list and clinical medication decision. METHODS ：Using“metastatic renal cell carcinoma ”“mRCC”“sunitinib”“sorafenib”“pazopanib”“cost-effectiveness” “cost-utility”“cost-benefit”“economic analysis ”as the Chinese and English retrieval words ，relevant literatures published during Jan. 1st，2006 to Jul. 15th，2019 were retrieved from PubMed ，Web of Science ，the Cochrane Library ，CNKI，Wanfang database ， VIP. The literatures were screened according to inclusion and exclusion criteria . The quality of the included literatures was evaluated with CHEERS scale. The effectiveness and economy of sunitinib ，sorafenib and pezoparib in the treatment of mRCC were compared qualitatively after the relevant data were extracted. RESULTS ：A total of 10 literatures were included ，and the total coincidence rates of 7 literatures over 75.00％. Among the 4 literature studies of sulatinib vs. sorafenib ，3 literature studies pointed out that sulatinib was the absolute advantage scheme ，and 1 literature study pointed out that sorafenib was more economical ； among the 6 literature studies of sunitinib vs. pezoparib ，4 literature studies indicated that pezoparib was the absolute advantage scheme，and 2 literature studies indicated that sunitinib was more economical. CONCLUSIONS ：In most cases ，the efficacy and economy of pezoparib in the treatment of mRCC is better than sunitinib and sorafenib ，but real world data shows that sunitinib is more economical.
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OBJECTIVE：To know about the research status of health utility value obtained by mapping method in pharmacoeconomic evaluation ，and to provide reference for bibliometric study in pharmacoeconomic evaluation . METHODS ： Using“Mapping method ”“Health utility value ”“Cost-utility”“Utility point system ”as Chinese and English keywords ，retrieved from CNKI ，Wanfang database ，PubMed，Medline，Ebsco，Ovid and Wiley database ，empirical journal documents published from the inception to Dec. 31st，2018 about using mapping method to obtain health utility value were collected. The bibliometrics was used to statistically analyze basic information of included literature ，the construction and test of the model ，the type of the best model and so on. RESULTS ：The 124 included documents were all published in English journal. In the construction and testing of the mapping model ，the most frequently used econometric methods ，performance evaluation indicators and model testing methods were ordinary least squares （OLS），mean absolute error （MAE）and residual normality test ，application frequency of which were 97 times（31.60％），89 times（24.93％）and 62 times（21.09％）. There are 117 articles that define the best mapping model ，of which 101 articles（86.32％）have the best direct mapping effect. Most of the non-utility measurement scales adopted specific scales （92 articles，77.97％），and a few literatures adopted the universal scale （26 articles，22.03％）. The most utility measurement scales were 3-level European 5-dimensional health scale （79 articles，66.95％）. CONCLUSIONS ：The domestic empirical researches that use the mapping method to obtain health utility values need to be developed yet. A series of mapping models successfully developed by foreign scholars not only provide the feasibility of using non-utility measurement scales for cost-utility analysis ，but also provide more ideas for China to choose the corresponding econometric methods ，evaluation indicators and mapping methods in the empirical research of the mapping method in the future.
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OBJECTIVE： To analyze the development situation of pharmacoeconomic evaluation research in China， and to provide reference for pharmacoeconomics discipline construction. METHODS： China journal full-text database was searched by computer. The searching time was from database establish to Dec. 2018. After collecting the academic papers with the theme of “pharmacoeconomic evaluation”， statistical analysis was made on publication year， source journals， institutions， authors， cooperation publication， citation information and keywords of papers by bibliometric method. RESULTS & CONCLUSIONS： A total of 1 197 literatures were included. The earliest literature was published in 1993， and the largest number （104 pieces） was published in 2015. The literatures came from 289 journals. Among which， China Pharmacy published the largest number of literatures （123 pieces）； the first author came from 619 institutions， which mainly were China Pharmaceutical University （124 pieces）； a total of 2 352 authors were involved， and 923 literatures were completed by two or more authors， with co-authorship rate of 77.1％. The total number times of authors was 3 480， and the degree of cooperation was 2.91. As of April 19， 2019， 975 literatures had been cited. The cited rate was 81.4％， the average citation frequency was 5.83 times， and the H-index was 29. There were a total of 1 922 keywords in the literatures， the top three keywords in the list of frequency were pharmacoeconomics （805 times）， cost-effectiveness analysis （209 times）， and pharmacoeconomic evaluation （98 times）. It could be seen that the research literatures on pharmacoeconomic evaluation in China were published earlier and widely distributed； the research content of the literatures was comprehensive， and some literatures had high influence. But the total number of literatures is still small and is distributed unevenly， and the number of core authors is insufficient， and related research needs to be further developed.
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Objective:To discuss the methods and meaning of constructing and applying the standard disease model based on pharmacoeconomie evaluation in China.Methods:Methods of theoretical analysis and qualitative research were applied.Results:There was feasible technology and methods for constructing and applying the standard disease model hased on pharmacoeconomic evaluation,which had great significance on improving the efficiency and reliability of the pharmacoeconomic evaluation.However,the major challenges came from the accumulation and integration of basic data.Conclusion:It was necessary and important to apply standard disease model in pharmacoeconoc evaluation,but the data gap must be filled.
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OBJECTIVE: Analyze the applications and challenges of guidelines for pharmacoeconomic evaluation (PE) in China. METHODS: Reviewing what Chinese health policy need from pharmacoeconomics; analyzethe applications and challenges of guidelines for PE in China; summarize the application and development of the guidelines for PE in the world. RESULTS: PE plays an important role in Drug development, pricing, reimbursement and evidenc-based clinical pathway. Since PE guidelineis not mandatory in healthcare policy decision making in China, and there are lack of high-quality, reliable database for PE, the guideline encountered many difficulties and challenges in practice and hasn't play its due role yet. CONCLUSION: Based on the experience from other counties and practical in China, we recommended that PEguideline shouldbe mandatory. It is recommended to set up national research institutions for PE, and update or supplementthe guidelines regularly. Moreover, the basic research should be strengthened, such as rational drug use, pharmacoepidemiology, quality of life.
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OBJECTIVE: To conduct an economic evaluation of Baofukang versus Langyi in the treatment of pregnancy with vulvovaginal candidiasis by means of cost-minimization analysis. Furthermore, provide reference for reasonable clinical prescription and decision-making. METHODS: Meta-analysis was conducted to support the safety data and effectiveness data of pharmacoeconomic evaluation based on literature review; guidelines and clinical experts' suggestion were used to find out treatment routes to calculate total direct medical costs. Cost-minimization analysis was conducted from the societal perspective. RESULTS: The total direct medical costs of group Baofukang was lower than group Langyi's. Sensitivity analysis indicated the results were robust. CONCLUSION: In contrast with Langyi, Baofukang is a more economic therapy in the treatment of pregnancy with vulvovaginal candidiasis.
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Since the positive listing system for prescription drug reimbursement has been introduced in Korea, the number of pharmacoeconomic evaluation studies has increased. However it is not clear if the quality of pharmacoeconomic evaluation study has improved. Due to the lack of randomized clinical studies in Korean health care setting, Korean economic evaluation studies have typically integrated the local cost data and foreign clinical data. Therefore methodological issues can be raised in regard to data coherence and consistency. But the quality of data was not questiened and the potential bias has not been investigated yet. Even though changes in policy have encouraged the undertaking of pharmacoeconomic evaluations, there is few public-side funding for validation study of cost-effectiveness models and data. Several companies perform economic evaluation studies to be submitted on behalf of their own products, but do not want the study results to be disclosed to the academic community or public. To improve the present conduct of pharmacoeconomic evaluations in Korea, various funding sources need to be developed, and, like other multidisciplinary areas, the experts in different fields of study should collaborate to ensure the validity and credibility of pharmacoeconomic evaluations.
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Humans , Cost-Benefit Analysis , Economics, Pharmaceutical/legislation & jurisprudence , Formularies as Topic , Korea , Pharmaceutical Preparations/economics , Technology Assessment, BiomedicalABSTRACT
0.05), and the treatment costs of the two groups were 30 235.20 yuan and 36 950.40 yuan, respectively (P
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0.05,X 2 =0.45),and the focus stability ratio were42.5%and32.4%respectively.Compared with the FOLFOX4group,the hospitalization course in capecitabine group is significantly shorter(8.5days vs25.3days,P=0.000)and the total medical cost was significantly lower(5941.7RMB vs13304.6RMB,P=0.001).The cost structure analysis showed that the direct and indirect medical costs of the FOLFOX4group increased more significantly(P=0.001)and the incidence for adverse effects of this group was lower than that of the capecitabine group.CONCLUSION:From the perspective of pharmacoeconomic evaluation,capecitabine is better than FOLFOX4in treating the digestive malignant tumor.
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OBJECTIVE:To provide reference information for development and application of pharmacoeconomics evaluation in China.METHODS:To introduce the different roles of pharmacoeconomic evaluation in the world.RESULTS &CONCLUSION:It's necessary for China to formulate pharmacoeconomic guidelines and use it in drug pricing,drug reimbursement,clinical guidance,diseases prevention and new drug R&D.
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OBJECTIVE:To assess the current situation of pharmacoeconomic evaluation studies in China.METHODS:A total of351papers on pharmacoeconomic evaluation,published in Chinese academic journals,issued before year2003,were systematically reviewed.RESULTS:It was improper and nonstandard that Chinese researcher handled the theories,methodologies and analysis techniques of pharmacoeconomic evaluation.CONCLUSION:Further academic communication and the initiative and formulation of the guidelines for pharmacoeconomic evaluation will be necessary to improve the research quality and clinically rational use of pharmaceuticals and serve the formulation of related policies.