The Pharmacoeconomic Evaluation Of Coronary Heart Disease With Angina Pectoris Based On The Net Benefit Regression Framework

Objective:Through the decomposition to the incremental cost-effectiveness ratio, construct a net benefit framework for the output indicators, and applying the econometric methods, the socio-demographic characteristics of each group of patients and diseases features are included in the analysis framework. Based on the framework, pharmacoeconomics evaluation of the two drugs taken by angina pectoris is assessed. Then analyze the net impact for the patients of different treatment options by controlling the confounding factors on treatment outcome applied the econometric models, and provided a better decision-making basis for the selection and pricing of drugs for decision-makers.Methods:This study is the prospective observational study. The research data are from "the study of Angina Drug Economics". To determine the object of study according of all criteria,316 cases are chosen. The cost index is the total cost, which is paid for the treatment of patients with angina pectoris during the period of investigation. The efficacy index is the efficacy of Chinese medicine symptom score. The utility index is the quality-adjusted life-days. The benefit is converted by the effect or utility with the introduction of the threshold of patient willingness to pay. The covariates and subgroup are determined according to the different demographic features, health behavior and health status after data is edited. The net benefits of the samples of 316 cases and four subgroups are analyzed. And the sensitivity of the maximum willingness to pay for patients is analyzed at the same time.Contents:Firstly,after data cleansing of the overall cases data (N=316), the baseline, CEA, CUA, and ICER will be analysised.Based on the results, whither it is necessary for a net benefit regression analysis and which covariates will be included in the regression model. Ultimately determine the appropriate net benefit regression model. Secondly, the net benefit regression was analysised based on the selected regression model.And identified the threshold of the patient's willingness to pay (WTP), and then the pharmacoeconomics evaluation for the two interventions about the angina pectoris of coronary heart disease was studied to compare their economical difference.Finally, the net benefit of the subgroup was analysised to compare the subgroups economical difference. As well as the sensitivity analysis was carried out on the willingness to pay according to the final selected regression model, determining the threshold of WTP, and the P value of the net benefit and the cost-effectiveness acceptability curves.Results:1. From the perspective of patients, for the efficiency indicators of Traditional Chinese Medicine (TCM) syndromes, compared to the treatment A, the incremental cost-effectiveness ration of group B (ICER) are as follows:(1) According to the analysis of the overallall cases(N=316), the ICER is?2284.40.(2) According to the subgroup analysis of "work", in the analysis of "working"(N=146), the ICER was ? 1996.55. In the analysis of "unemployment & retired"(N=102), the ICER was Y6019.51.(3) According to the subgroup analysis of " the conditions of chronic ", in the analysis of "suffering from other chronic diseases"(N=133), the ICER was ? 2652.33; In the analysis of "without other chronic"(N=110), the ICER was ? 1012.47.2. From the patient perspective, A, the maximum willingness to pay thresholds ?0 B patients with two treatment options is as follows:(1) In all cases,316 cases of data analysis, Xo is?1140.25.(2) According to the "work" subgroup analysis in 146 cases of "working" in the case of data analysis,?0 is equal to Y 1019.81. In 102 cases of " unemployment & retired' case data analysis, ?0is? 1299.45.(3) According to the subgroup analysis of " the conditions of chronic ", in the analysis of "suffering from other chronic diseases"(N=133),?0 is? 1332.38. In the analysis of "without other chronic"(N=110), h is ? 1053.37.3. According to all the groups' analysis, included the overall group and the four subgroups, the results of CUA showed a lower cost and a better utility. Therefore, it can be directly determine the group B is more economical without the net benefit regression analysis.Conclusions:1. The first conclusion on the applicability is as follows: Only when the ICER>0, in other words, the high cost can get more effectiveness or the lower cost results of a less effectiveness, it is necessary and valuable for the net benefit regression analysis.2. The second conclusion on the net benefit regression analysis is as follows: From the perspective of patients, influenced by the maximum willingness to pay value (?) and the different conditions of working and suffering from other chronic diseases the economy of the two treatments will correspondingly change. For the patients with the lower ?, the drug of B is more cost-effective advantages. The specific results are as follows:(1) According to overall analysis, when X<Y 1140.25, the group B is more economical; when ?> ?1140.25, select A program more economical.(2) According to the subgroup analysis of "work", in the analysis of "working"(N=146) when ?<?1019.81, the group B is more economical; when ?> ?1019.81, the group A is more economical. In the analysis of "unemployment & retired" (N=102), when ?< ? 1299.45, the group B is more economical; when ?> ? 1299.45, the group A is more economical.(3) According to the subgroup analysis of" the conditions of chronic ", in the analysis of "suffering from other chronic diseases"(N=133), when ?< ? 1332.38, the group B is more economical; when ?> ? 1332.38, the group A is more economical. In the analysis of "without other chronic"(N=110), when ?< ? 1053.37, the group B is more economical, when ?> ? 1053.37, the group A is more economical.