Objective  To evaluate the long-term cost-utility of Huangkui capsule compared with losartan potassium tablets in the treatment of IgA nephropathy.

Methods  Using quality-adjusted life years (QALYs) as the effect index to establish the Markov model of chronic kidney disease in stage 1-5, a 20-year Markov cohort simulation with a cycle of 1 year was carried out to calculate the incremental cost-utility ratio (ICUR). Taking GDP per capita in 2020 as the willingness to pay (WTP) threshold, and one-way and probabilistic sensitivity analysis were carried out to evaluate the long-term economy.

Results  Compared with losartan potassium tablets, the ICUR of Huangkui capsule was 36 334.47 yuan/QALY, which was less than the WTP threshold and had a economic advantage. The results of one-way sensitivity analysis showed that Huangkui capsule was still economical after the parameters changed in a certain range. The probabilistic sensitivity analysis showed that when WTP threshold was GDP per capita, acceptable probability of Huangkui capsule was much higher than that of losartan potassium tablets, indicating that the baseline analysis results were robust.

Conclusion  Huangkui capsule has better clinical efficacy and long-term economic advantages than losartan potassium tablets in the treatment of IgA nephropathy.

1.肖翠霞, 洪时萃, 周建馨, 等. 中西医结合治疗成人原发性IgA肾病疗效的meta分析[J]. 中国中西医结合肾病杂志, 2021, 22(1): 19-24. [Xiao CX, Hong SC, Zhou JX, et al. Meta-analysis on efficiency of integrated tradi-tional chinese and western medicine therapy for primary IgA nephropathy in adult patients[J]. Chinese Journal of Integrated Traditional and Western Nephrology, 2021, 22(1): 19-24.] DOI: 10.3969/j.issn.1009-587X. 2021.01.006.

2.中华医学会, 主编. 临床诊疗指南（肾脏病学分册）[M]. 北京：人民卫生出版社, 2011: 39-43.

3.National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification[J]. Am J Kidney Dis, 2002, 39(2 Suppl 1): S1-S266. https://pubmed.ncbi.nlm.nih.gov/11904577/

4.宗楠. 终末期肾病血液透析和腹膜透析疾病经济负担及影响因素[D]. 郑州: 郑州大学, 2017. [Zong N. The study of economic burden and influencing factor on hemodialysis and peritoneal dialysis for ESRD patients[D]. Zhengzhou: Zhengzhou University, 2017.]

5.喻佳洁, 高学敏, 李平, 等. 中成药标准化指南制订的思考与建议：以慢性肾脏病为例[J]. 中国循证医学杂志, 2019, 19(12): 1477-1480. [Yu JJ, Gao XM, Li P, et al. Considerations and suggestions for standardizing clinical practice guideline of traditional Chinese patent medicine-chronic renal disease as an example[J]. Chi-nese Journal of Evidence-Based Medicine, 2019, 19(12): 1477-1480.] DOI: 10.7507/1672-2531.201811001.

6.秦林, 丛旭东. 探讨黄葵胶囊的临床应用及机制[J]. 中国中西医结合肾病杂志, 2009, 10(8): 730-731. [Qin L, Cong XD. To explore the clinical application and mechanism of Huangkui capsule[J]. Chinese Journal of Inte-grated Traditional and Western Nephrology, 2009, 10(8): 730-731.] DOI: 10.3969/j.issn.1009-587X.2009. 08.027.

7.何立群, 主编. 中成药临床应用指南·肾与膀胱疾病分册[M]. 北京: 中国中医药出版社, 2017: 177-204.

8.Beck L, Bomback AS, Choi MJ, et al. KDOQI US commentary on the 2012 KDIGO clinical practice guide-line for glomerulonephritis[J]. Am J Kidney Dis, 2013, 62(3): 403-441. DOI: 10.1053/j.ajkd.2013.06.002.

9.张宁, 夏天. 黄葵胶囊联合氯沙坦治疗IgA肾病102例临床观察及分析[J]. 中国中西医结合肾病杂志, 2010, 11(12): 1108. [Zhang N, Xia T. Clinical observation and analysis of 102 cases of IgA nephropathy treated with Huangkui capsule and losartan[J]. Chinese Journal of Integrated Traditional and Western Nephrology, 2010, 11(12): 1108.] DOI: 10.3969/j.issn.1009-587X.2010. 12.028.

10.Li P, Lin H, Ni Z, et al. Efficacy and safety of abelmoschus manihot for IgA nephropathy: a multicenter randomized clinical trial[J]. Phytomedicine, 2020, 76: 153231. DOI: 10.1016/j.phymed.2020.153231.

11.翟龙燕. 慢性肾小球肾炎蛋白尿患者的中医证候与实验室检查结果的关系研究[D]. 兰州: 兰州大学, 2018. [Zhai LY. Study on characteristics of TCM syndromes types of proteinuria in chronic primary glomerulonephri-tis[D]. Lanzhou: Lanzhou University, 2018.]

12.Sugrue DM, Ward T, Rai S, et al. Economic modelling of chronic kidney disease: a systematic literature review to inform conceptual model design[J]. Pharmacoeconomics, 2019, 37(12): 1451-1468. DOI: 10.1007/s40273-019-00835-z.

13.刘迅, 凌莉, 王成, 等. 多状态Markov模型在慢性肾脏病分级预后研究中的应用[J]. 第二军医大学学报, 2009, 30(7): 804-807. [Liu X, Ling L, Wang C, et al. Application of Markov model in studying graded prognosis of chronic kidney disease[J]. Academic Journal of Naval Medical University, 2009, 30(7): 804-807.] DOI: 10.3724/SP.J.1008.2009.00804.

14.Anwar NMMR. A stochastic model for the progression of chronic kidney disease[J]. JLERA, 2014, 11(4): 8-19.https://scholar.cu.edu.eg/?q=nouraanwar/publications/stochastic-model-progression-chronic-kidney-disease.

15.Elbasha E, Greaves W, Roth D, et al. Cost-effectiveness of elbasvir/grazoprevir use in treatment-naive and treatment-experienced patients with hepatitis C virus genotype 1 infection and chronic kidney dis-ease in the United States[J]. J Viral Hepat, 2017, 24(4): 268-279. DOI: 10.1111/jvh.12639.

16.刘国恩, 主编. 中国药物经济学评价指南(2020中英双语版)[M]. 北京: 中国市场出版社, 2020: 27-47.

17.Begun A, Icks A, Waldeyer R, et al. Identification of a multistate continuous-time nonhomogeneous Markov chain model for patients with decreased renal function[J]. Med Decis Making, 2013, 33(2): 298-306. DOI: 10.1177/0272989X12466731.

18.黎夏, 魏登军. 慢性肾病患者住院医疗费用负担分析[J]. 公共卫生与预防医学, 2015, 26(6): 64-67. [Li X, Wei DJ. Distribution and influence factors of medical expenditure in inpatients withchronic kidney disease[J]. Journal of Public Health and Preventive Medicine, 2015, 26(6): 64-67.] https://d.wanfangdata.com.cn/periodical/ggwsyyfyx201506018.

19.Wu J, Yang L. PUK5-The economic burden of chronic kidney disease in China[J]. Value Health, 2013, 16(3): A181. DOI: 10.1016/j.jval.2013.03.909.