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不同决策分析模型在抗肿瘤药物经济学评价中的应用——以加拿大CADTH为例
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| 篇名： | 不同决策分析模型在抗肿瘤药物经济学评价中的应用——以加拿大CADTH为例 |
| TITLE： | Application of Different Decision Analysis Models in the Economic Evaluation of Antitumor Drugs ：Taking CADTH in Canada as an Example |
| 摘要： | 目的：为我国抗肿瘤药物经济学评价的模型选择、以及我国肿瘤药物药物经济学评价证据质量的提升提供参考。方法：在加拿大药品与卫生技术局（CADTH）官网对抗肿瘤药物卫生技术评估（pCODR）报告进行系统检索，报告时间限定为2015年1月1日－2020年9月6日，对其基本信息、模型类型及结构、模型中存在的关键问题等进行提取与总结。结果与结论：共检索获得185份pCODR报告，涉及114种肿瘤适应证和98种抗肿瘤药物。近5年CADTH抗肿瘤药物经济学评价数量呈递增趋势。在137份附有最终经济性指导报告的pCODR报告中，98份报告（占71.5％）使用了分区生存模型进行评估，21份报告（占15.3％）使用了状态转移模型，还有部分报告（6份，4.3％）同时使用了分区生存模型和状态转移两种模型以探讨模型结构的不确定性。在模型健康状态设定方面，86份报告（占62.8％）使用了三状态模型以评估不同抗肿瘤药物的经济性，还有16份报告（占11.7％）使用了不少于4种健康状态来模拟疾病的状态转归。但CADTH模型中尚存在研究时限选择不合理、疗效（生存）数据外推方法不合理或外推结果不确定、通过间接比较获取的疗效数据不确定以及部分假设或参数设置不符合实际诊疗环境等问题。鉴于分区生存模型的诸多优势，建议我国未来抗肿瘤药物经济学评价优先考虑使用分区生存模型或联合使用马尔可夫模型与分区生存模型来验证模型结构的不确定性，并合理设置重点模型参数，以提升我国抗肿瘤药物经济学评价的证据质量。 |
| ABSTRACT： | OBJECTIVE：To provide referenc e for selectin g antitumor drugs economic evaluation models and improving the quality of evidence for antitumor drugs economics evaluation in China. METHODS ：A systematic search of the antitumor drug health technology evaluation （pCODR）reports were conducted on the official website of the Canadian Agency for Drugs and Technologies in Health （CADTH）. The search time was limited to Jan. 1st，2015 to Sep. 6th，2020. The basic information ，model types and structure ，and key limitations were extracted and summarized. RESULTS & CONCLUSIONS ：A total of 185 pCODR reports were finally retrieved ，involving 114 types of tumor indications and 98 types of antitumor drugs. The number of CADTH antitumor drugs economics evaluations in the past 5 years had shown an increasing trend. Among 137 pCODR reports with final economic guidance report ，98 reports（71.5％）adopted the PartSA model ，21 reports（15.3％）used the Markov model ，and some reports（6 reports，4.3％）used both PartSA and Markov models to explore the uncertainty of the model structure. In terms of model health status setting ，86 reports（62.8％）used three-state models to evaluate the economy of different anti tumor drugs ，and 16 reports（11.7％）used no less than four health states to simulate the outcome of disease state. However ，there were still some problems in CADTH models ，such as the unreasonable choice of research time limit ，the unreasonable extrapolation method or uncertain extrapolation results of efficacy （survival）data，the uncertainty of efficacy data obtained by indirect comparison ，and some assumptions or parameter settings did not conform to the actual diagnosis and treatment environment. In view of the advantages of PartSA model ，it is suggested that PartSA model or Markov model combined with PartSA model should be used first to verify the uncertainty of model structure in the future economic evaluation of antitumor drugs ；reasonable settings of key model parameters should be considered to improve the quality of evidence for antitumor drugs economics evaluation in China. |
| 期刊： | 2021年第32卷第14期 |
| 作者： | 孟蕊，芮明军，王欣恬，杨岚，王子婧，马爱霞 |
| AUTHORS： | MENG Rui，RUI Mingjun ，WANG Xintian ，YANG Lan，WANG Zijing，MA Aixia |
| 关键字： | 加拿大药品与卫生技术局；抗肿瘤药物；经济学评价；马尔可夫模型；分区生存模型 |
| KEYWORDS： | CADTH；Antitumor drug ；Economic evalua- |
| 阅读数： | 532 次 |
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