我国牛奶蛋白过敏患儿配方粉替代治疗方案的经济学评价

周慧君, 王薇, 王沛

doi:10.13688/j.cnki.chr.2023.230117

健康发展与政策研究 >

2023 , Vol. 26 >Issue 5: 452 - 461

DOI: https://doi.org/10.13688/j.cnki.chr.2023.230117

卫生经济

我国牛奶蛋白过敏患儿配方粉替代治疗方案的经济学评价

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1. 上海理工大学管理学院, 上海 200093;
2. 复旦大学公共卫生学院, 上海 200032

周慧君，特聘教授，博士，主要从事卫生经济学、卫生技术评估、药物经济学建模、卫生系统和政策、公共卫生、临床真实世界研究，lockgo2luck@126.com

收稿日期: 2023-04-03

修回日期: 2023-07-20

网络出版日期: 2023-12-07

基金资助

国家自然科学基金项目（72274037）

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摘要

目的评估起始使用氨基酸配方（amino acid formula，AAF）和深度水解配方（extensively hydrolyzedformula，eHF）治疗牛奶蛋白过敏（cow's milk allergy，CMA）患儿的经济性，为患儿家庭在疾病膳食管理过程中优选性价比高的配方粉，同时也为临床医生选择处方提供相应的经济学证据。方法以我国2岁以下CMA患儿为研究对象，构建决策树模拟其临床路径，并进行成本效果分析。模型从患者视角出发，评估患儿在治疗CMA过程中的直接医疗成本和2岁前建立牛奶蛋白耐受所需要的时间（效果指标）。从成本和效果2个方面综合对比评估起始使用AAF或eHF对CMA患儿疾病膳食管理的经济性。结果起始使用AAF替代喂养的CMA患儿获得牛奶蛋白耐受所需时间平均为7.15个月（其中轻中度CMA患儿平均需要6.41个月，重度CMA患儿平均需要10.11个月）。患儿2岁前配方粉饮食替代喂养的诊疗及家庭护理等总成本平均为23 455元。起始使用eHF替代喂养的CMA患儿获得牛奶蛋白耐受所需时间平均为10.50个月（其中轻中度CMA患儿平均需要9.58个月，重度CMA患儿平均需要14.13个月）。起始使用eHF的总平均成本高于AAF，无乳糖eHF的总成本平均为30 592元，略低于含乳糖eHF的31 337元。与起始使用eHF替代喂养相比，使用AAF替代喂养不管是对轻中度还是重度CMA患儿都具有绝对的经济学优势，且重度CMA患儿获益更大。在考虑模型参数的各种不确定性后，AAF仍有92.0%以上的概率为优选的CMA管理配方。结论相较于eHF，起始使用AAF替代喂养对于我国CMA患儿治疗具有绝对的经济学优势，是一种性价比较高的治疗方案。

关键词： 牛奶蛋白过敏; 成本效果分析; 氨基酸配方; 深度水解配方

本文引用格式

周慧君, 王薇, 王沛 . 我国牛奶蛋白过敏患儿配方粉替代治疗方案的经济学评价[J]. 健康发展与政策研究, 2023 , 26(5) : 452 -461 . DOI: 10.13688/j.cnki.chr.2023.230117

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