2012-12-10
Lu L et al.“Cost Effectiveness of Oromucosal Cannabis-Based Medicine (Sativex®) for Spasticity in Multiple Sclerosis”， Pharmacoeconomics 2012, 30(12): pp.1157-1171.
Background: Spasticity is common in patients with multiple sclerosis (MS) and is a major contributor to disability. Sativex®, an oromucosal spray containing cannabis-based medicinal products, has been found to be effective in reducing spasticity symptoms.
Objective: Our objective was to estimate the cost effectiveness of Sativex® plus oral anti-spasticity medicines compared with the current standard treatment for moderate or severe spasticity in MS in the UK.
Methods: A Markov model was used to assess the costs and benefits of Sativex® plus oral anti-spasticity medicines or current standard treatment based on their effects on the quality of life of patients. The main outcome was the incremental cost-effectiveness ratio (ICER) in terms of costs per additional QALY gained over 5 years of treatment. One-way, multi-way and probabilistic sensitivity analyses were conducted to explore the impact of uncertainties on the findings.
Results: In the base case, Sativex® plus oral anti-spasticity medicines resulted in incremental costs of £7600 and a QALY gain of 0.15 per person over 5 years (ICER = £49 300 per QALY). Findings were sensitive to the costs of Sativex® (price and dose) and differences in utilities between responders and non-responders.
Conclusions: Using a willingness-to-pay threshold of £30 000 per QALY, Sativex® appears unlikely to be considered cost effective by UK funders of healthcare for spasticity in MS. This is unfortunate, since it appears that Sativex® use is likely to benefit some patients in the management of this common consequence of MS.
口服大麻类药物(Sativex®)用于控制多发性硬化症引起的痉挛的价值评估
摘要：研究背景：痉挛是多发性硬化症的常见症状，也是造成患者生活不便的主要因素。Sativex®是一种口服大麻类药物，临床研究发现该药能有效减缓痉挛发作。研究目的：对Sativex®（对比英国现有标准治疗）用于控制多发性硬化症引起的痉挛的进行价值评估。研究方法：使用马科夫模型对采用Sativex®治疗产生的费用和治疗效果进行模拟评估。评估主要成果是药品的增量成本效益比（ICER），并使用多种敏感性分析对不确定因素的影响进行了探索研究。研究发现：在基础案例中，使用Sativex®的患者在5年内需要多出7600磅的医疗费用，同时也多得到0.15个生活质量调整生存年。模拟结果对Sativex®的费用和Sativex®的疗效产生的生活质量提高非常敏感。研究结论：如果英国的医疗保健资助机构愿意支付不多于3万英镑来增加一个生活质量调整生存年，那么Sativex®用于控制多发性硬化症引起的痉挛在大多数情况下不会被认为是“物有所值”。这个结合英国经济因素的评估结果非常令人遗憾，因为Sativex®的确能够缓解部分患者的痉挛，而痉挛是造成患者生活不便的主要因素。(Pharmacoeconomics，2012年，SSCI/SCI)
