Long-termphanrmacoeconomic Evaluation Of Low-income Patients With Rheumatoid Arthritis Using Markov Model

Rheumatoid arthritis(RA)is a kind of chronic systemic disease.With the development of the disease,joint dysfunction will gradually emerge and lead to the incapacity of the patient to work.At present,the drugs to treat RA mainly include first-line anti-inflammatory and analgesic drugs,traditional synthetic anti-rheumatism drugs to improve the condition,biological agents and small molecule compounds.With the increased awareness and compliance of RA patients to the disease,some RA patients who take regular medicine can achieve low disease activity degree.And with the constant development of new biological preparations in recent years,some severe RA patients have obtained ideal treatment effect.However,under financial pressure,low-income RA patients cannot insist on long-term treatment.Clinical physicians can significantly improve the patient's enthusiasm and compliance by choosing a treatment plan with high economic cost and benefit within the range of the patient's economic capacity.Therefore,it is a new revolution under the current medical economic situation to vigorously carry out the research on drug economics in low-income people,which is in the same important position with the research and development of new drugs,and has a historical significance that cannot be ignored in guaranteeing the coverage of basic drug treatment and saving individual and social costs.This topic fills at home and abroad on low-income RA patients use drug economics to guide the clinical treatment of the blank,more use of economic model analysis for the first time the low-income anti-rheumatism medicine with different RA patients improve disease(diseases,modifying anti-rheumatic drugs,DMARDs)cost-benefit differences between treatments.The development of pharmacoeconomics has important practical significance in guiding long-term rational drug use and controlling medical cost for patients with chronic diseases.Part I Observation of therapeutic effect of common therapy for rheumatoid arthritisRA disease progression can lead to pulmonary fibrosis,pericarditis,severe vasculitis,and even life-threatening.Early diagnosis and early combined drug treatment are effective methods to delay the progress of patients with RA,improve the quality of life and save some medical costs due to the control of the disease.The combination of different drugs will result in different therapeutic effects.The experimental basis for the next step is to compare and calculate the indicators of pharmacoeconomics such as cost-benefit and cost-effect.By observing the changes of the indexes after the treatment of the four groups,this study compared and analyzed the different effects.The results showed that four regimens were developed for low-income RA patients,methotrexate MTX and the biological drug etanerceptCombination therapy is the most effective.However,the economic cost of Ecep is relatively high,which also raises the next research question for us,whether the treatment scheme with high economic cost has high pharmacoeconomic value for low-income people.This shows that in order to develop a treatment plan in line with the patient's condition,we not only need to choose a treatment plan that is beneficial to the improvement of the patient's condition,but also need to consider the financial burden of the patient to some extent.The treatment plan we choose should be a treatment strategy that is feasible in both treatment effect and economic bearing.Part ? Pharmacoeconomic analysis of the treatment of low incomepatients with rheumatoid arthritisRA therapeutic drugs currently include traditional synthetic improvements anti-rheumatism medicine(but these diseases,modifying anti-rheumatic drugs cDMARDs)anti-rheumatism medicine,biological synthesis improve disease(biologic diseases-modfying antirheumatic drugs bDMARDs),small molecule compounds,such as drug price difference is several times or even more.And low-income RA patients do not have the financial capacity to afford expensive biological agents in the long run.The use of pharmacoeconomics to evaluate the treatment of RA can optimize the treatment plan of patients,which is another revolutionary progress after the targeted molecular drug treatment,and can promote RA patients to make more reasonable and full use of the current drug research results.This topic reviewed the clinical indicators and the cost to the patient,using drug economics analysis between different RA treatment cost-benefit,and further comparative analysis between cDMARDs,bDMARDs clinical therapeutic effects of different drug treatments and risk,in order to further develop economic ability to withstand low RA patients within the scope of the rationalization of essential medicines to provide clinical data treatment.The results showed that the combined application of MTX+DMARDs had the advantage of cost-effectiveness analysis,while the cost per quality-adjusted life year QALY obtained by the single-use MTX treatment was the lowest.These results suggest that for low-income RA patients,the traditional drug MTX can be first selected as the treatment regimen,and the combination drug regimen can be considered when the efficacy of MTX is not good.Part ? Evaluation of long-term pharmacoeconomics of different treatments using Markov modelRA is a chronic disease that requires long-term drug treatment.Therefore,in order to evaluate long-term economic effects that patients and clinicians pay attention to,the prospective analysis method is one of the currently feasible effective approaches.Based on this research background,this study used Markov model Markov model to simulate the clinical process of MTX+DMARDs,MTX,DMARDs and MTX+Ecep treatment for 30 years(60 cycles),in order to predict and evaluate the economic benefits of different drug combination treatment regimens for long-term treatment of low-income RA patients.The results show that no matter what treatment regimen is used,early treatment can reduce medical costs if the same treatment effect is achieved.The cost-benefit ratio of MTX in four different drug treatment regimens met the economic threshold for low-income patients.MTX+Ecep has the highest cost-benefit,but beyond the economic threshold.This suggests that MTX can be preferred in the long-term treatment of low-income RA patients for disease remission,and MTX combined with DMARDs can be considered when the curative effect is not good,and finally MTX combined with biological agent Ecep can be considered.This also indicates that the cost and therapeutic effect should be considered during the treatment of chronic diseases,especially for patients with low-income population,reasonable control of drug cost is more conducive to long-term treatment.Therefore,using Markov economic model to simulate the analysis of drug economy for long-term treatment of chronic diseases has important reference value at the present stage.