易解鐵(Exjade®) 治療海洋性貧血病人鐵質沉積之藥物經濟評估

A Pharmaco-economic Evaluation of Exjade in Treating Patients with Iron Overload Caused by Thalassemia

林凱信(Kai-Hsin Lin)

指導教授 ： 鍾國彪

國立臺灣大學/公共衛生學院/健康政策與管理研究所/碩士(2011年)

https://doi.org/10.6342/NTU.2011.10399

摘要

研究目的：
利用藥物經濟學評估方法，探討易解鐵是否能有效將鐵質沉積排出病人身體，以及在台灣實行之經濟效用。
研究設計：
利用Markov model模擬方法，分析病人終身可能發生鐵沉積併發症或死亡的醫療費用，比較兩種藥物使用下之差異。
研究參數：
藥價由藥廠提供。
併發症之醫療費用從全民健康保險局資料庫整理而來。
研究結果：
從基本個案分析顯示，以易解鐵治療的病人比以deferoxamine治療的病人可望有較少的併發症發生率，而且壽命或品質調整壽命增長兩年或三年以上。但是，終身使用易解鐵的病人，比使用deferoxamine的病人，整體的醫療費用每人將增加36,291美元。將醫療費用和結果指標合在一起計算，增加費用利用率，平均每人增加每一年品質調整壽命，使用易解鐵者，必須多花費15,596美元。敏感度分析中可以看出，易解鐵的單價影響費用利用率最大。此外，延遲使用易解鐵，也會增加費用利用率。
研究結論：
比較打針的deferoxamine與口服的易解鐵兩種排鐵劑，口服的易解鐵不但臨床效果進步，而且生命的品質在合理的花費下也可提高。

關鍵字

海洋性貧血 ； 易解鐵 ； 排鐵劑 ； 成本效益分析 ； 藥物經濟學 ； 健康品質存活

並列摘要

Objective:
To propose a study, which employs the pharmaco-economic approach to prove that Exjade is not only effective medication in patients suffering from iron overload, but is also cost-effective if administered in Taiwan.
Design:
By using the Markov model provided by Norvatis, the lifetime occurrence of complications/death as well as costs will be simulated for patients treated with either Exjade or deferoxamine.
Parameters:
Drug costs: provided by Norvatis.
Treatment costs for complications are from Bureau of the National Health Insurance (BNHI).
Results:
Results of base case analysis show that, if treated with deferasirox, patients were expected to have fewer incidences of complications and obtain two more life years or three more quality-adjusted life-years (QALYs) than those who treated with deferoxamine. However, the total medical cost during the lifetime under the circumstances of using deferasirox would be 36,291 USD more per patient than that of using deferoxamine. After combining cost and outcomes indicators to become an incremental cost-utility ratio, it is estimated that 15,596USD is needed for obtaining an additional QALY for each patient treated with deferasirox. Sensitivity analyses show that unit cost of deferasirox has the greatest impacts on the incremental cost-utility ratio. In addition, the incremental cost-utility ratio would increase if delaying the starting age of chelation therapy.
Conclusions:
Comparing to the injection type of deferoxamine, deferasirox could improve clinical outcomes as well as quality-of-life at a reasonable cost.

並列關鍵字

thalassemia ； deferasirox ； deferoxamine ； cost-effectiveness pharmoco-economics ； quality-adjusted life year

參考文獻

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[49]莊宇勝，本土失智症機構照護收容模式成本效果分析，未發表的碩士論文，台北：臺灣大學醫療機構管理研究所，2007。

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