Objective  To compare the cost and utility of aflibercept and conbercept for the treatment of wet age-related macular degeneration (wetAMD), in order to provide a reference for the selection of treatment regimens from the perspective of pharmacoeconomics.

Methods  The incremental cost-utility ratio (ICUR) was obtained by using Markov model to simulate the survival of the two treatment regimens over the 5-year period, calculating costs and health outputs separately. Univariate sensitivity analysis was used to determine the impact of the parameter on ICUR, and probability sensitivity analysis was used to determine the influence of the uncertainty of each model parameter on the research results. One times the 2022 gross domestic product (GDP) per capita of China was used as the willingness-to-pay threshold (WTP) to judge its economy.

Results  Over the simulation period, the compazine regimen was significantly economical against the aflibercept regimen, with an ICUR of -1 528 840 per quality-adjusted life year (QALY), which was lower than the WTP. Univariate sensitivity analysis showed that the transition probability between mild and moderate visual status between the two regimens and the number of aflibercept injections per year were significant influencing factors of ICUR. Probabilistic sensitivity analysis pointed to a significant cost-utility advantage for conbercept at a WTP of one times GDP (probability of 65.9%), which was a more robust result.

Conclusion  For the treatment of wetAMD, conbercept has a cost-utility advantage compared with aflibercept.

1.朱胜钰, 刘昳. 湿性年龄相关性黄斑变性研究进展与未来展望[J]. 系统医学, 2023, 8(13): 186-190. [Zhu SY, Liu Y. Research progress and future prospects of wet age-related macular degeneration[J]. Journal of Systems Medicine, 2023, 8(13): 186-190.] DOI: 10.19368/j.cnki.2096-1782.2023.13.186.

2.张敬法, 赵珍珍. 湿性年龄相关性黄斑变性发病机制及治疗[J]. 眼科新进展, 2022, 42(2): 85-98. [Zhang JF, Zhao ZZ. Pathogenesis and treatment of wet age-related macular degeneration[J]. New Advances in Ophthalmology, 2022, 42(2): 85-98.] https://www.cnki.com.cn/Article/CJFDTOTAL-XKJZ202202001.htm.

3.Miller JW, Bagheri S, Vavvas DG. Advances in age-related macular degeneration understanding and therapy[J]. US Ophthalmic Rev, 2017, 10(2): 119-130. DOI: 10.17925/usor.2017.10.02.119.

4.Solomon SD, Lindsley K, Vedula SS, et al. Anti-vascular endothelial growth factor for neovascular age-related macular degeneration[J]. Cochrane Database Syst Rev, 2019, 3(3): Cd005139. DOI: 10.1002/14651858.CD005139.pub4.

5.张静, 李翔, 谭萨, 等. 雷珠单抗在眼科的应用研究进展[J]. 中医眼耳鼻喉杂志, 2013, 3(2): 109-111, 116. [Zhang J, Li X, Tan S, et al. Research progress on the application of ranibizumab in ophthalmology[J]. Journal of Eye and Otolaryngology of Traditional Chinese Medicine, 2013, 3(2): 109-111, 116.] DOI: 10.3969/j.issn.1674-9006.2013.02.016.

6.祝颖星, 邹悦, 冯萧萧, 等. 阿柏西普治疗糖尿病性黄斑水肿的研究进展[J]. 国际眼科纵览, 2023, 47(1): 74-78. [Zhu YX, Zou Y, Feng XX, et al. Research progress of aflibercept in the treatment of diabetic macular edema[J]. Int Rev Ophthalmol, 2023, 47(1): 74-78. DOI: 10.3760/cma.j.issn.1673-5803.2023.01.014.

7.Zhang J, Liang Y, Xie J, et al. Conbercept for patients with age-related macular degeneration: a systematic review[J]. BMC Ophthalmol, 2018, 18(1): 142. DOI: 10.1186/s12886-018-0807-1.

8.王彦博, 赵明娟, 王强, 等. 2021年中国发布临床实践指南利益冲突与经济学证据的调查分析[J]. 医学新知, 2023, 33(1): 8-49. [Wang YB, Zhao MJ, Wang Q, et al. Investigation and analysis of conflict of interest and economic evidence in the 2021clinical practice guidelines published in China[J]. Yixue Xinzhi Zazhi, 2023, 33(1): 8-49.] DOI: 10.12173/j.issn.1004-5511.202210053.

9.Cui Z, Zhou W, Chang Q, et al. Cost-effectiveness of conbercept vs. ranibizumab for age-related macular degeneration, diabetic macular edema, and pathological myopia: population-based cohort study and Markov model[J]. Front Med (Lausanne), 2021, 8: 750132. DOI: 10.3389/fmed.2021.750132.

10.Liu K, Song Y, Xu G, et al. Conbercept for treatment of neovascular age-related macular degeneration: results of the randomized phase 3 PHOENIX study[J]. Am J Ophthalmol, 2019, 197: 156-167. DOI: 10.1016/j.ajo.2018.08.026.

11.Ohji M, Takahashi K, Okada AA, et al. Efficacy and safety of intravitreal aflibercept treat-and-extend regimens in exudative age-related macular degeneration: 52- and 96-week findings from ALTAIR: a randomized controlled trial[J]. Adv Ther, 2020, 37(3): 1173-1187. DOI: 10.1007/s12325-020-01236-x.

12.谭重庆, 彭六保, 曾小慧, 等. 药物经济学评价中敏感度分析的参数分布[J]. 中国新药与临床杂志, 2015, 34(12): 961-964. [Tan CQ, Peng LB, Zeng XH, et al. Parameter distribution of sensitivity analysis in pharmacoeconomic evaluation[J]. Chinese Journal of New Drugs and Clinical Medicine, 2015, 34(12): 961-964. DOI: 10.14109/j.cnki.xyylc.2015.12.015.

13.刘佳, 蒋亚文, 倪惟一, 等. 抗VEGF类药物与传统激光疗法用于治疗糖尿病性黄斑水肿的药物经济学评价[J]. 中国药学杂志, 2020, 55(5): 402-407. [Liu J, Jiang YW, Ni WY, et al. Pharmacoeconomic evaluation of anti-VEGF drugs versus traditional laser therapy in the treatment of diabetic macular edema[J]. Chinese Journal of Pharmaceutical Sciences, 2020, 55(5): 402-407. DOI: 10.11669/cpj.2020.05.013.

14.Gao L, Tao Y, Liu M, et al. Different conbercept injection strategies for the treatment of exudative age-related macular degeneration: a retrospective cohort study[J]. Medicine (Baltimore), 2020, 99(7): e19007. DOI: 10.1097/md.0000000000019007.

15.扬州市人民政府. 视力一级残疾人的护理费标准是多少？如何申请？[EB/OL]. (2022-02-09) [2023-11-21]. http://www.yangzhou.gov.cn/yangzhou/zskqt/202202/90db95ce95744ee6ad71f80e84b68cfe.shtml.

16.李文爽, 戴泽琦, 孙庆冉, 等. 2018-2022年我国中药药物经济学研究文献的质量评价[J]. 中国药房, 2023, 34(19): 2378-2384. [Li WS, Dai ZQ, Sun QR, et al. Quality evaluation of pharmacoeconomics research literature in Chinese medicine from 2018 to 2022[J]. China Pharmacy, 2023, 34(19): 2378-2384. DOI: 10.6039/j.issn.1001-0408.2023.19.13.

17.王李婷, 彭六保, 彭烨, 等. 2020年版和2011年版中国药物经济学评价指南比较分析[J]. 中国药物经济学, 2021, 16(3): 5-8, 15. [Wang LT, Peng LB, Peng Y, et al. Comparative analysis between 2020 version and 2011 version on China Guidelines for Pharmacoeconomic Evaluation[J]. China Journal of Pharmaceutical Economics, 2021, 16(3): 5-8, 15.] DOI: 10.12010/j.issn.1673-5846. 2021.03.001.

18.卢丹丹, 王声祥, 卢姗, 等. 沙库巴曲缬沙坦、达格列净和恩格列净治疗射血分数降低心力衰竭的成本-效用分析[J]. 药物流行病学杂志, 2023, 32(8): 878-885. [Lu DD, Wang SX, Lu S, et al. Cost-utility analysis of sacubitril-valsartan, dapagliflozin, and empagliflozin in the treatment of heart failure reduction with ejection fraction[J]. Chinese Journal of Pharmacoepidemiology, 2023, 32(8): 878-885.] DOI: 10.19960/j.issn.1005-0698.202308006.

19.Filipovic-Pierucci A, Zarca K, Durand-Zaleski I. Markov models for health economic evaluation modelling in r with the heemod package[J]. Value in Health, 2016, 19(7): A369. DOI: 10.1016/j.jval.2016.09.133.

20.李会, 刘学勤, 傅钰仙, 等. 湿性年龄相关性黄斑变性患者就医延迟现状及影响因素分析[J]. 护士进修杂志, 2022, 37(14): 1338-1343. [Li H, Liu XQ, Fu YX, et al. Analysis of the delay in seeking medical treatment in patients with wet age-related macular degeneration and its influencing factors[J]. Journal of Advanced Nursing Education, 2022, 37(14): 1338-1343.] DOI: 10.16821/j.cnki.hsjx.2022.14.019.

21.赵宁, 徐俊杰, 万超, 等. 老年性黄斑变性研究热点的文献计量分析[J]. 中华眼底病杂志, 2011, 27(6): 577-581. [Zhao N, Xu JJ, Wan C, et al. Bibliometric analysis of research hotspots in age-related macular degeneration[J]. Chinese Journal of Fundus Diseases, 2011, 27(6): 577-581.] DOI: 10.3760/cma.j.issn.1005-1015.2011.06.018.

22.姜旭光, 苏争宏. 康柏西普不同用药方案治疗湿性年龄相关性黄斑变性的疗效及安全性对照研究[J]. 检验医学与临床, 2023, 20(8): 1170-1172, 1184. [Jiang XG, Su ZH. Controlled study on the efficacy and safety of different medication regimens of Conbercept in the treatment of wet age-related macular degeneration[J]. Laboratory Medicine & Clinical Medicine, 2023, 20(8): 1170-1172,1184.] DOI: 10.3969/j.issn.1672-9455.2023.08.036.

23.祁媛媛, 崔林, 张莉, 等. 反复玻璃体腔注射雷珠单抗与阿柏西普对黄斑水肿患者角膜神经的影响[J]. 国际眼科杂志, 2023, 23(5): 848-851. [Qi YY, Cui L, Zhang L, et al. Effect of repeated intravitreal injections of ranibizumab and aflibercept on corneal nerves in patients with macular edema[J]. Int J Ophthalmol, 2023, 23(5): 848-851.] DOI: 10.3980/j.issn.1672-5123.2023.5.25.

24.张雪, 谈仪炯, 熊学惠, 等. 基于FDA不良事件报告系统数据库的阿柏西普眼内注射溶液不良反应信号挖掘[J]. 临床药物治疗杂志, 2024, 22(1): 65-70. [Zhang X, Tan YJ, Xiong XH, et al. Signal mining of adverse reaction reaction of aflibercept intraocular injection solution based on FDA adverse event reporting system database[J]. Journal of Clinical Pharmacotherapy, 2024, 22(1): 65-70.] DOI: 10.3969/j.issn.1672-3384.2024.01.014.