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目的 评估非奈利酮治疗糖尿病肾病（DKD）的经济性。方法 基于临床试验和相关文献数据构建马尔可夫模型。模型循环周期为4个月，模拟时限为20年，年贴现率为5%，采用我国2023年人均国内生产总值（GDP）的1倍作为意愿支付（WTP）阈值。以质量调整生命年（QALY）为效用指标，计算增量成本-效用比（ICUR）。采用单因素敏感性分析和概率敏感性分析来验证基础分析结果的稳健性。结果 非奈利酮联合标准治疗方案相较于安慰剂联合标准治疗方案的ICUR为43035.3728元/QALY，低于本研究的WTP阈值（89358元/QALY）。单因素敏感性分析结果显示，非奈利酮价格对ICUR影响较大，但模型稳健性未受影响。概率敏感性分析结果显示，在该研究WTP阈值下，非奈利酮联合标准治疗方案更具经济性。结论 与安慰剂联合标准治疗方案相比，DKD患者使用非奈利酮联合标准治疗方案具有经济性。
Abstract：AIM To evaluate the cost-utility of finerenone plus standard therapy in the treatment of diabetic kidney disease(DKD). METHODS Markov model was constructed based on the clinical trial and related literature. The cycle length was set at 4 months with a time horizon of 20 years, applying an annual discount rate of 5%. The willingness-to-pay(WTP) threshold was established as one time China's 2023 per capita gross domestic product(GDP). Quality adjusted life year(QALY) was the utility index, and the incremental cost-utility ratio(ICUR) was calculated accordingly. The robustness of the results was verified by one-way sensitivity analysis and probabilistic sensitivity analysis. RESULTS The ICUR of finerenone combined with standard treatment was 43035.3728 yuan/QALY, which was lower than the WTP threshold of 89358 yuan/QALY in the study. The results of one-way sensitivity analysis showed that the finerenone price greatly influenced ICUR, but did not affect the robustness of the model. The results of probabilistic sensitivity analysis showed that finerenone plus the standard treatment regimen was more economical under the WTP threshold of the study. CONCLUSION Finerenone combined with standard therapy is economical in DKD patients compared with standard therapy.
[1] GANSEVOORT R T, CORREA-ROTTER R, HEMMELGARN B R, et al. Chronic kidney disease and cardiovascular risk:epidemiology, mechanisms, and prevention[J]. Lancet, 2013,382(9889):339.
[2] DENG Y J, LI N, WU Y, et al. Global, regional, and national burden of diabetes-related chronic kidney disease from 1990 to2019[J]. Front Endocrinol, 2021, 12:672350.
[3]范文君,祝菁菁,黄韻宇,等.我国糖尿病肾病的流行现状及其危险因素[J].中国慢性病预防与控制, 2013, 21(6):748.
[4]中华医学会糖尿病学分会微血管并发症学组,薛耀明,朱大龙.中国糖尿病肾脏病防治指南(2021年版)[J].国际内分泌代谢杂志,2021, 41(4):388.
[5] NAVANEETHAN S D, ZOUNGAS S, LUIZA CARAMORI M, et al. Diabetes management in chronic kidney disease:synopsis of the KDIGO 2022 clinical practice guideline update[J]. Ann Intern Med, 2023, 176(3):381.
[6] BOMBACK A S, KLEMMER P J. The incidence and implications of aldosterone breakthrough[J]. Nat Clin Pract Nephrol, 2007,3(9):486.
[7] BAKRIS G L, AGARWAL R, ANKER S D, et al. Effect of finerenone on chronic kidney disease outcomes in type 2 diabetes[J]. N Engl J Med, 2020, 383(23):2219.
[8] ROSSING P, LUIZA CARAMORI M, CHAN J C N, et al.Executive summary of the KDIGO 2022 clinical practice guideline for diabetes management in chronic kidney disease:an update based on rapidly emerging new evidence[J]. Kidney Int, 2022,102(5):990.
[9]中华医学会肾脏病学分会专家组.糖尿病肾脏疾病临床诊疗中国指南[J].中华肾脏病杂志, 2021, 37(3):255.
[10]《非奈利酮在糖尿病合并慢性肾脏病患者中应用的中国专家共识（2023版）》专家组.非奈利酮在糖尿病合并慢性肾脏病患者中应用的中国专家共识(2023版)[J].中华肾脏病杂志, 2023, 39(10):800.
[11]拜尔中国.拜耳可申达(非奈利酮片)在中国获批[EB/OL].(2022-06-30)[2024-03-01]. https://www.bayer.com.cn/zh-hans/665.
[12]上海市肾内科临床质量控制中心专家组.慢性肾脏病早期筛查、诊断及防治指南(2022年版)[J].中华肾脏病杂志, 2022(5):453.
[13] NUIJTEN M, ANDRESS D L, MARX S E, et al. Cost Effectiveness of Paricalcitol versus a non-selective vitamin D receptor activator for secondary hyperparathyroidism in the UK:a chronic kidney disease Markov model[J]. Clin Drug Investig, 2010, 30(8):545.
[14] ELBASHA E, GREAVES W, ROTH D, et al. Cost-effectiveness of elbasvir/grazoprevir use in treatment-naive and treatment-experienced patients with hepatitis C virus genotype 1 infection and chronic kidney disease in the United States[J]. J Viral Hepat, 2017, 24(4):268.
[15]中华人民共和国国家卫生健康委员会. 2021年我国卫生健康事业发展统计公报[EB/OL].(2022-07-12)[2024-03-01]. https://www.nhc.gov.cn/wjw/c100381/202207/6aa5c4c7db614cceab727599675a4929.shtml.
[16] QUIST S W, VAN SCHOONHOVEN A V, BAKKER S J L, et al. Costeffectiveness of finerenone in chronic kidney disease associated with type 2 diabetes in The Netherlands[J]. Cardiovasc Diabetol, 2023,22(1):328.
[17] GIDWANI R, RUSSELL L B. Estimating transition probabilities from published evidence:a tutorial for decision modelers[J].Pharmacoeconomics, 2020, 38(11):1153.
[18]刘畅,陶立波,陆灏,等.渴络欣胶囊联用化学药治疗糖尿病肾病的药物经济学评价[J].中国药房, 2022, 33(17):2124.
[19]苟亮文,郭昭廷,罗琼,等.黄葵胶囊对比氯沙坦钾片治疗IgA肾病的药物经济学评价[J].药物流行病学杂志, 2023, 32(1):2.
[20]中国药学会.中国药学会关于发布《中国药物经济学评价指南2020》团体标准的公告[EB/OL].(2020-12-03)[2024-03-01].https://www.cpa.org.cn/index.php?do=info&cid=75553.
[21]国家统计局.国务院新闻办就2023年国民经济运行情况举行发布会[EB/OL].(2024-01-17)[2024-03-01]. https://www.gov.cn/lianbo/fabu/202401/content_6926619.htm.
[22] LIU W L, ZHANG D, WANG R B, et al. Global trends in the burden of chronic kidney disease attributable to type 2 diabetes:an age-periodcohort analysis[J]. Diabetes Obes Metab, 2024, 26(2):602.
[23] ERIKSEN B O, INGEBRETSEN O C. The progression of chronic kidney disease:a 10-year population-based study of the effects of gender and age[J]. Kidney Int, 2006, 69(2):375.
[24] ELSAYED N A, ALEPPO G, ARODA V R, et al. 16. diabetes care in the hospital:standards of care in diabetes-2023[J]. Diabetes Care,2023, 46(Suppl 1):S267.
基本信息:
DOI：10.19577/j.1007-4406.2025.06.008
中图分类号:R692.9;R587.2
引用信息:
[1]周宇,张铭,李辉,等.非奈利酮治疗糖尿病肾病的成本-效用分析[J].中国临床药学杂志,2025,34(06):447-453.DOI:10.19577/j.1007-4406.2025.06.008.
2025-06-25
2025-06-25