Efficacy and cost of different treatment in patients with idiopathic membranous nephropathy: A network meta-analysis and cost-effectiveness analysis
Autor: | Shiyuan Wang, Weihua Xie, Xiaojin Yu, Pinyuan Dai, Jinfang Sun, Joseph Kawuki |
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Rok vydání: | 2021 |
Předmět: |
0301 basic medicine
medicine.medical_specialty Cyclophosphamide Cost-Benefit Analysis Network Meta-Analysis Immunology Glomerulonephritis Membranous Gastroenterology law.invention 03 medical and health sciences Pharmacoeconomics 0302 clinical medicine Randomized controlled trial law Internal medicine medicine Humans Immunology and Allergy Randomized Controlled Trials as Topic Leflunomide Pharmacology Chlorambucil business.industry Therapeutic effect medicine.disease Treatment Outcome 030104 developmental biology 030220 oncology & carcinogenesis Rituximab business Nephrotic syndrome medicine.drug |
Zdroj: | International Immunopharmacology. 94:107376 |
ISSN: | 1567-5769 |
Popis: | Background Idiopathic membranous nephropathy (IMN) is the most common pathological type of adult nephrotic syndrome. However, the treatments for IMN patients had not been compared from the perspectives of therapeutic effect and pharmacoeconomics. Therefore, a network meta-analysis and a cost-effectiveness analysis were conducted to find the optimum treatment for IMN patients. Methods Randomized controlled trials (RCTs) which compared the treatments including cyclophosphamide (CTX), mycophenolate mofetil (MMF), cyclosporine (CsA), tacrolimus (TAC), leflunomide (LEF), chlorambucil (CLB) and rituximab (RTX) for patients with IMN were reviewed. The complete and partial remission rates were extracted and then compared by network meta-analysis. The surface under the cumulative ranking area (SUCRA) was calculated to rank the remission rate for all treatments. Then, the cost-effectiveness analysis was performed to compared the incremental cost-effectiveness ratio (ICER) of different treatments. Results A total of 75 articles with 4806 participants were included according to the inclusion and exclusion criteria. Compared with the glucocorticoids (GC) group, CTX + GC (95%RR 1.02,1.76), CsA + GC (95%RR 1.11,2.13) and TAC + GC (95%RR 1.44,2.59) were associated with a significantly higher rate of complete remission. TAC + GC were most likely to be ranked the best (SUCRA of 92.1%). From the perspective of the cost-effectiveness analysis in China, the ICER of LEF + GC to CTX + GC was $30616.336 per unit utility, and that of TAC + GC to CTX + GC was $670475.210 per unit utility. And the ICER of CTX + GC to LEF + GC in the UK was $-65680.879 per unit utility. Conclusions CTX + GC was the cheapest treatment with obvious curative effect in China, while LEF + GC was a cost-effective alternative to CTX + GC. The remission rate of TAC + GC was highest despite the high single-dose cost. |
Databáze: | OpenAIRE |
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