Objective  To evaluate the cost-effectiveness of low-dose steroid combined with tacrolimus or cyclophosphamide in treating adult idiopathic membranous nephropathy (IMN).

Methods  A prospective cohort design was used to collect clinical data on IMN patients admitted to the Affiliated Hospital of Hebei University from December 2018 to April 2022. The patients were divided into the exposure group (low-dose steroid combined with tacrolimus) and control group (low-dose steroid combined with cyclophosphamide) according to the treatment regimen. Propensity score matching was employed to balance the baseline characteristics between the two groups. The total response rate was taken as the effect index, cost-effectiveness analysis was conducted by using the decision tree model, and single factor sensitivity analysis and probabilistic sensitivity analysis were used to verify the robustness of the cost-effectiveness analysis results.

Results  A total of 112 patients with IMN were included. After propensity score matching, 46 patients were included in the exposed and control groups, respectively. The total remission rate of the exposure group was 84.78%, with the cost of 13,352.64 yuan and the cost-effectiveness ratio of 157.50. In the control group, the total remission rate was 80.43%, the cost was 8,154.18 yuan, and the cost-effectiveness ratio was 101.38. The incremental cost-effectiveness ratio of the two groups was 1 195.05, and the sensitivity analysis results were consistent with those of the cost-effectiveness analysis.

Conclusion  The two treatment schemes have their own advantages in the treatment of IMN. The cost-effectiveness ratio of low-dose hormone combined with tacrolimus is relatively higher, and the combination of low-dose hormone with cyclophosphamide is more economical. Both schemes have certain clinical promotion value..

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