The Cost-effective Analysis of TNF-αInhibitors in the Treatment of Rheumatoid Arthritis

目的：旨在通过临床使用剂量和以美国风湿病学会（ACR）得分作为效果测量，比较肿瘤坏死因子（TNF-α）抑制剂治疗类风湿性关节炎的成本-效果。方法：从全社会角度，对传统改善病情的抗风湿药（DMARDs）治疗失败的成年患者，比较TNF-α抑制剂（依那西普、英夫利昔单抗和阿达木单抗，单用或联用甲氨蝶呤））治疗1年的成本-效果。结果：英夫利昔单抗+MTX治疗RA 1年的成本最低，为215093元；阿达木单抗治疗RA 的成本最高，为279735元。TNF-α抑制剂联用MTX治疗RA的成本都比TNF-α抑制剂单用的成本低。在疗效（ACR20, ACR50, ACR70）方面，英夫利昔单抗+MTX治疗RA效果最差，分别为42%、21%和11%；依那西普+MTX效果最好，分别为85%、69%和43%。TNF-α抑制剂联用MTX治疗RA的效果都比TNF-α抑制剂单用的效果好。结论：TNF-α抑制剂联用MTX的效果比单用更好，在三种TNF-α抑制剂中，依那西普联用MTX最具有成本-效果。Objectives Based on dosages and scores obtained by American College of Rheumatology (ACR) to conduct cost-effectiveness analysis of TNF-α inhibitors in the treatment of rheumatoid arthritis (RA). Methods DMARDs (disease-modifying anti-rheumatic drugs) treatment failed adult patients were selected, and one year cost-effectiveness of treatment using Etanercept, Infl iximab or Adalimumab was compared. Results Treatment of Infl iximab +MTX has the lowest cost (215093 RMB), while Adalimumab has the highest cost (279735 RMB). The TNF-α inhibitors +MTX cost less than TNF-α inhibitors does. For the effectiveness, Infl iximab +MTX has the worst treatment effects, with ACR20, ACR50 and ACR70 being 42%, 21% and 11%, respectively; while Etanercept+MTX has the best treatment effects, with ACR20, ACR50 and ACR70 being 85%, 69% and 43%, respectively. The TNF-α inhibitors +MTX have better treatment effects than TNF-α inhibitors does. Conclusions The treatment of TNF-α inhibitors +MTX has better effect than only TNF-α inhibitors does. Among the three TNF-α inhibitors, Etanercept +MTX is the most cost-effect treatment method.国家自然科学基金面上项目653-5