背景:成本效益分析通常忽略医疗保健系统资源限制。由于疾病患病率增加和资源密集型治疗的使用,眼科受到资源限制的影响。这项研究评估了资源限制对法利单抗6毫克成本效益的影响,与阿柏西普2毫克和雷珠单抗生物仿制药0.5毫克相比,用于治疗湿性年龄相关性黄斑变性(wAMD)或糖尿病性黄斑水肿(DMO),为期5年。
方法:一个微观模拟模型估计了资源限制对患者就诊的影响,延迟,成本和质量调整寿命年(QALY)损失由于在一个典型的英国国家卫生服务眼科医院治疗1500例wAMD患者和500例DMO患者的治疗延误.患者特征,使用已发表的文献和专家意见告知治疗方案和治疗间隔.资源限制是通过限制每周可用的玻璃体内注射预约次数来表示的。随着疾病患病率上升引起的需求增长。该模型比较了三种情况下的结果;每种情况都涉及用三种治疗方法之一治疗所有患者。
结果:超过5年,在一家资源有限的医院,与aflibercept相比,法利单抗的使用避免了12,596次延误,节省了英镑/15,108,609英镑的成本,避免了60.06个QALY的损失。与雷珠单抗生物仿制药相比,法利玛的使用避免了18910次延误,产生了2,069,088英镑的额外费用,避免了105.70QALY的损失,导致增量成本效益比为19,574GB/QALY。
结论:在卫生经济评估中考虑资源约束至关重要。新兴疗法更持久,需要较少的诊所就诊,可以减少治疗延误。改善QALY结果,减轻医疗系统负担。Faricimab减少了延迟注射的次数,在资源有限的医疗保健系统中,改善患者的QALY结果。与阿柏西普相比,Faricimab节省成本,与雷珠单抗生物仿制药相比具有成本效益。
BACKGROUND: Cost-effectiveness analyses typically ignore healthcare system resource constraints. Ophthalmology is affected by resource constraints because of increasing disease prevalence and the use of resource-intensive treatments. This study evaluated the impact of resource constraints on the cost-effectiveness of faricimab 6 mg, compared with aflibercept 2 mg and ranibizumab biosimilar 0.5 mg, for treating wet age-related macular degeneration (wAMD) or diabetic macular oedema (DMO) over a 5-year horizon.
METHODS: A microsimulation model estimated the impact of resource constraints on patients visits, delays, costs and quality-adjusted life-year (QALY) losses due to treatment delays at a typical UK National Health Service eye hospital treating 1500 patients with wAMD and 500 patients with DMO. Patient characteristics, treatment regimens and treatment intervals were informed using published literature and expert opinion. Resource constraint was represented by limiting the number of available intravitreal injection appointments per week, with growing demand caused by rising disease prevalence. The model compared outcomes across three scenarios; each scenario involved treating all patients with one of the three treatments.
RESULTS: Over 5 years, in a resource-constrained hospital, compared with aflibercept, faricimab use resulted in the avoidance of 12,596 delays, saved GBP/£15,108,609 in cost and avoided the loss of 60.06 QALYs. Compared with ranibizumab biosimilar, faricimab use resulted in the avoidance of 18,910 delays, incurred £2,069,088 extra cost and avoided the loss of 105.70 QALYs, resulting in an incremental cost-effectiveness ratio of £19,574/QALY.
CONCLUSIONS: Accounting for resource constraints in health economic evaluation is crucial. Emerging therapies that are more durable and require less frequent clinic visits can reduce treatment delays, leading to improved QALY outcomes and reduced burden on healthcare systems. Faricimab reduced the number of delayed injections, leading to improved QALY outcomes for patients in a healthcare system with resource constraints. Faricimab is cost-saving when compared with aflibercept and cost-effective when compared with ranibizumab biosimilar.