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目的 开展氯米芬和来曲唑用于促排卵治疗的药物经济学评价，为临床用药和医保支付提供真实世界证据。方法 回顾性分析2020年1月至2021年12月某三甲医院妇科行氯米芬或来曲唑诱导排卵的排卵障碍性不孕症患者628例，1 232个排卵周期，合计1 232例次。按照促排卵药物种类进行分组，分为氯米芬组（281例次）和来曲唑组（951例次）。利用TreeAge Pro 2022软件建立决策树模型，对2组促排卵方案分别进行成本-效果分析，并进行敏感性验证。结果 氯米芬组治疗成本和效果分别为1 107.91元和0.107，来曲唑组治疗成本和效果分别为1 163.36元和0.161，增量成本-效果比为1 023.92，低于支付意愿值（12 545元）。可负担性分析提示，氯米芬组与来曲唑组的单周期促排卵的可负担系数均<1，即2种药品可负担性均良好。结论 与氯米芬相比，来曲唑用于促排卵治疗更具成本-效果分析优势。
Abstract：AIM To conduct a pharmacoeconomic evaluation of ovulation induction with clomiphene and letrozole, providing real-world evidence to inform clinical decision-making and medical insurance reimbursement. METHODS A retrospective analysis was performed on 628 patients with ovulatory disorder infertility who underwent clomiphene-or letrozole-induced ovulation at the Department of Gynecology in a tertiary hospital from January 2020 to december 2021, The study included 1 232 ovulatory cycles total. According to the ovulation-inducing medication used, cycles were categorized into "Cycle Group A"(clomiphene group, 281 cycles) and "Cycle Group B"(letrozole group, 951 cycles). A decision-tree model was developed using TreeAge Pro 2022 to conduct a cost-effectiveness analysis for both types of ovulation-induction regimens, followed by sensitivity analyses. RESULTS In the cycle group analysis, the clomiphene group showed treatment costs and effectiveness of 1 107.91 yuan and 0.107, respectively, whereas the letrozole group showed 1 163.36 yuan and 0.161, respectively. The incremental cost-effectiveness ratio(ICER) was 1 023.92 yuan, below the willingness-to-pay(WTP) threshold(12 545 yuan). Affordability analysis showed that affordability coefficients for single-cycle ovulation induction were less than 1 for both the clomiphene group and the letrozole group, suggesting good affordability for both drugs. CONCLUSION Compared with clomiphene, letrozole demonstrates superior costeffectiveness for ovulation induction.
[1]孙文希,胡凌娟.国内外不孕不育症现状及我国的干预策略探讨[J].人口与健康, 2019(12):19.
[2]孔北华,马丁,段涛.妇产科学[M]. 10版.北京:人民卫生出版社, 2024:21-35.
[3]CARSON S A, KALLEN A N. Diagnosis and management of infertility:a review[J]. JAMA, 2021, 326(1):65.
[4]马堃,韩梅,杨思红,等.排卵障碍性不孕症中西医结合诊疗指南[J].中医杂志, 2024, 65(9):976.
[5]吴坚,金方.复方玄驹胶囊联合来曲唑治疗排卵障碍性不孕症的疗效及对患者激素水平的影响[J].中国临床药学杂志, 2020,29(4):253.
[6]AL-THUWAYNEE S, SWADI A A J. Comparing efficacy and safety of stair step protocols for clomiphene citrate and letrozole in ovulation induction for women with polycystic ovary syndrome(PCOS):a randomized controlled clinical trial[J]. J Med Life,2023, 16(5):725.
[7]LIU Z, GENG Y L, HUANG Y J, et al. Letrozole compared with clomiphene citrate for polycystic ovarian syndrome:a systematic review and meta-analysis[J]. Obstet Gynecol, 2023, 141(3):523.
[8]ABU-ZAID A, GARI A, SABBAN H, et al. Comparison of letrozole and clomiphene citrate in pregnancy outcomes in patients with polycystic ovary syndrome:a systematic review and metaanalysis[J]. Reprod Sci, 2024, 31(4):883.
[9]何南南.枸橼酸氯米芬与来曲唑在多囊卵巢综合征不孕治疗中促排卵的效果对比[J].实用妇科内分泌电子杂志, 2020, 7(21):23.
[10]TEEDE H J, TAY C T, LAVEN J J E, et al. Recommendations from the 2023 international evidence-based guideline for the assessment and management of polycystic ovary syndrome[J]. J Clin Endocrinol Metab, 2023, 108(10):2447.
[11]莫晓嫦,冯兰青.来曲唑与氯米芬治疗多囊卵巢综合征患者的疗效比较[J].中国药物经济学, 2022, 17(6):86.
[12]SUN B, MA Y J, LI L, et al. Factors associated with ovarian hyperstimulation syndrome(OHSS)severity in women with polycystic ovary syndrome undergoing IVF/ICSI[J]. Front Endocrinol, 2021, 11:615957.
[13]《中国药物经济学评价指南》课题组,刘国恩,胡善联,等.中国药物经济学评价指南(2011版)[J].中国药物经济学, 2011,6(3):6.
[14]孙利华.药物经济学[M]. 4版.北京:中国医药科技出版社,2019:104-107.
[15]浙江省统计局. 2022年浙江统计年鉴[EB/OL].(2022-10-11)[2025-04-01]. https://tjj.zj.gov.cn/art/2022/10/11/art_1525563_58954684.html.
[16]PUSPITASARI I M, LEGIANAWATI D, SINURAYA R K, et al.Cost-effectiveness analysis of chemoradiation and radiotherapy treatment for stageⅡB andⅢB cervical cancer patients[J]. Int J Womens Health, 2021, 13:221.
[17]OGBUOJI O, SHAHID M, ZIMMERMAN A, et al. Costeffectiveness analysis of proactive home visits compared with sitebased community health worker care on antenatal care outcomes in Mali:a cluster-randomised trial[J]. BMJ Glob Health, 2024,9(12):e014940.
[18]PALUMBO A, DE LA FUENTE P, RODRÍGUEZ M, et al.Willingness to pay and conjoint analysis to determine women’s preferences for ovarian stimulating hormones in the treatment of infertility in Spain[J]. Hum Reprod, 2011, 26(7):1790.
[19]管晓东,林其敏,信枭雄,等.药品可负担性评价方法研究[J].中国药房, 2015, 26(28):3892.
[20]浙江省人民政府.浙江省人民政府关于调整全省最低工资标准的通知[EB/OL].(2021-07-29)[2025-04-01]. https://www.zj.gov.cn/art/2021/7/29/art_1229569592_2381230.html.
[21]浙江省统计局. 2021年浙江省国民经济和社会发展统计公报[EB/OL].(2022-02-24)[2025-04-01]. http://tjj.zj.gov.cn/art/2022/2/24/art_1229129205_4883213.html.
[22]BANSAL S, GOYAL M, SHARMA C, et al. Letrozole versus clomiphene citrate for ovulation induction in anovulatory women with polycystic ovarian syndrome:a randomized controlled trial[J].Int J Gynecol Obstet, 2021, 152(3):345.
[23]刘真,翟所迪.多囊卵巢综合征患者2种促排卵治疗方案的决策树分析[J].中国药房, 2012, 23(2):108.
[24]KOOHNAVARD F, AHMADI K , EFTEKHAR E , et al.Computational screening of FDA-approved drugs to identify potential aromatase receptor inhibitors for polycystic ovary syndrome[J]. J Biomol Struct Dyn, 2023, 41(24):15507.
[25]HOLZER H, CASPER R, TULANDI T. A new era in ovulation induction[J]. Fertil Steril, 2006, 85(2):277.
[26]PAJAI S, POTDAR J, GOPAL U, et al. A review on the use of letrozole in female and male infertility[J]. Cureus, 2022, 14:e312.
[27]徐蓓,魏莎蔓,靳镭.降低辅助生殖技术中多胎妊娠的对策[J].中国实用妇科与产科杂志, 2023, 39(10):978.
基本信息:
DOI：10.19577/j.1007-4406.2026.04.010
中图分类号:R711.6;R956
引用信息:
[1]徐静瑶,邵希跃,张秀华.氯米芬和来曲唑对排卵障碍性不孕症患者促排卵治疗的药物经济学评价[J].中国临床药学杂志,2026,35(04):348-353.DOI:10.19577/j.1007-4406.2026.04.010.
基金信息:
温州市市级科技计划项目（编号Y20240386）
2026-04-25
2026-04-25