| 引用本文: |
胡善联,何江江,杨燕,等.多维度决策分析在血友病预防性治疗中的应用[J].中国卫生经济,2017,(9):55-58.[点击复制] |
.Application of Multiple Criteria Decision Analysis in Prophylactic Therapy on Hemophilia A in China[J].CHINESE HEALTH ECONOMICS,2017,(9):55-58.[点击复制] |
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| 摘要: |
| 目的 比较影响血友病A治疗的主要疗效因素,评价不同治疗方案的优缺点，进而为治疗方案的决策提供参考。方法 采用多维度决策分析方法（MDCA），通过组织专家组会议，对反映血友病治疗效果的10个特性因素及其标准剂量的预防治疗、中低剂量预防治疗和按需治疗这三种治疗方案进行评分（分值区间为1-10分，1分为最不重要，10分为最重要）；并获得不同特性指标的权重。结果 根据专家打分反映血友病治疗效果的10个特性因素中主要影响因素为减少致残率、减少总出血(包括关节出血)次数、提高生活质量；而各治疗方案中按需治疗的方案获得的总分值最低（160.54），中、低剂量预防治疗分值居中（234.76），最高的是采用标准剂量预防治疗方案（263.84）；在各治疗方案内，减少总出血(包括关节出血)次数、减少致残率、提高患者生活质量、患者能正常生活学习工作这几个方面，临床专家普遍认为标准预防治疗方案最好；对费用分析后发现，标准剂量的预防治疗费用高（34.5万元），但治疗效果远好于中低剂量预防治疗和按需治疗方案。结论 从长期的成本效果分析来看，预防性治疗可以减少并发症的发生，并且降低终生的医疗成本。但目前我国各地对血凝8因子医保报销政策不同，而且补偿水平不一，急需进一步提高。 |
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| Application of Multiple Criteria Decision Analysis in Prophylactic Therapy on Hemophilia A in China |
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| Abstract: |
| Application of Multiple Criteria Decision Analysis in Prophylactic Therapy on Hemophilia A in ChinaShanlian Hu. 1,2 , Jiangjiang He 2, Yan Yang2, Qi Kang21.School of Public Health, Fudan University, ShangHai 200032. 2. Department of Health Policy Research, Shanghai Medical Information Center（Shanghai Health Development Research Center）, ShangHai 200040. OBJECTIIVES: To compare the main therapeutic factors of hemophilia A treatment, evaluate the advantages and disadvantages of different treatment programs, and then provide a reference for the decision of the treatment program.Using MDCA approach to evaluate the main attributes impact on the clinical efficacy and analyzes the strengths and weakness between FVIII treatment on-demand and prophylaxis in order to make consensus building in Chinese clinical key opinion leaders. METHODS: Using MDCA approach to evaluate the main attributes impact on the clinical efficacy and analyzes the strengths and weakness between FVIII treatment on-demand and prophylaxis in order to make consensus building in Chinese clinical key opinion leaders. The number of scores in each attribute is at the range from 1 to 10, 1 is the most important, 10 Divided into the most important; and access to different characteristics of the weight of indicators. RESULTS: The important attributes are reducing the number of bleedings, disability rate, and days of absenteeism from work/school, improve quality of life, return back to normal life. The total scores in treatment on-demand is the lowest one (160.54), low-dose prophylactic therapy is in the middle (234.76), the highest score is standard prophylactic therapy (263.84). In the treatment program, reduce the total number of bleeding (including joint bleeding), reduce morbidity, improve the quality of life of patients, patients can normal life and study of these aspects, clinical experts generally believe that the standard preventive treatment program the best; Analysis found that the standard dose of prevention and treatment costs are high (￥345,000 yuan), but the treatment effect is much better than the low dose of preventive treatment and on-demand treatment program. CONCLUSIONS: MCDA method can be used on clinical decision making on selecting hemophilia therapy. General speaking, the cost of lifelong prophylaxis is much less than that of treatment on-demand. However, In China, although the cost of FVIII treatment on-demand can be reimbursed by basic medical insurance system and catastrophic insurance scheme, it is inequity; the ratio of reimbursement and ceiling threshold various region by region. Prophylaxis therapy is a cost-effective regimen if it can be started in childhood stage. |
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