艾拉莫德联合甲氨蝶呤用于单药治疗失败的活动性类风湿关节炎患者的成本-效用分析OA

OBJECTIVE To evaluate the cost-utility of iguratimod combined with methotrexate in the treatment of patients with active rheumatoid arthritis(RA)who failed monotherapy with conventional synthetic disease-modifying antirheumatic drugs(csDMARDs).METHODS A cost-utility analysis was performed.A Markov model was constructed from the perspective of China's healthcare system with a cycle length of 6 months to simulate the costs and health outcomes[quality-adjusted life years(QALYs)]of iguratimod combined with methotrexate versus different combined csDMARDs regimens over a 30-year time horizon.Efficacy and safety data were synthesized from randomized controlled trials via network meta-analysis.Cost parameters were derived from the Menet Database,published literature and other sources.The discount rate was set at 4.5%,and the willingness-to-pay(WTP)threshold was twice China's per capita gross domestic product in 2025(199 330.00 yuan/QALY).One-way sensitivity analysis,probabilistic sensitivity analysis and scenario analysis were conducted to verify the robustness of the results.RESULTS Compared with methotrexate+sulfasalazine and sulfasalazine+leflunomide,iguratimod+methotrexate was a dominant regimen.Compared with methotrexate+leflunomide,the incremental cost-effectiveness ratio of iguratimod+methotrexate was 60 577.10 yuan/QALY,which was lower than the WTP threshold.Sensitivity analyses and scenario analysis confirmed favorable robustness of the above findings.CONCLUSIONS From the perspective of China's healthcare system,iguratimod+methotrexate is cost-effective for active RA patients failing csDMARD monotherapy,in comparison with methotrexate+leflunomide,methotrexate+sulfasalazine and sulfasalazine+leflunomide regimens.