两种不同重组人血小板生成素方案防治肺癌化疗所致血小板减少的效果及经济性比较

Comparison of efficacy and cost-effectiveness of two different recombinant human thrombopoietin regimens in prevention and treatment of chemotherapy-induced thrombocytopenia in patients with lung cancer

目的探究不同重组人血小板生成素(rhTPO)方案防治肺癌化疗所致血小板减少(CIT)的效果及经济性。方法回顾性收集2020年1月至2023年12月成都医学院第一附属医院收治的73例肺癌化疗后血小板降低至<75×10^(9)·L^(-1)患者,按照不同rhTPO治疗方案分为方案二组(n=39,每日300 U·kg^(-1))和方案一组(n=34,隔日300 U·kg^(-1)),比较两组用药后血小板(PLT)计数、不良反应及临床成本-效果比。结果两组用药第3、5、7、10 d时PLT值均差异无意义(P>0.05),方案一组升高至100×10^(9)·L^(-1)所需时间大于方案二组([7.21±4.03)d vs(5.90±4.52)d,P<0.05],其中方案一组和方案二组PLT峰值分别为(103.7±45.3)×10^(9)·L^(-1),(110.2±41.3)×10^(9)·L^(-1),组间比较差异无统计学意义(P>0.05);两组出现白细胞减少、贫血、恶性呕吐等不良反应概率比较差异无统计学意义(70.6%vs 56.4%,29.4%vs 23.1%,23.5%vs 17.9%,χ^(2)=1.269,0.572,0.847,P>0.05);方案一组总治疗费用、rhTPO成本均低于方案二组[(11.87±4.09)万元vs(13.79±5.23)万元,(4236.7±2906.3)元vs(6872.4±3673.5)元,t=7.154,3.269,P<0.05],且每提高一个疗效单位,方案一组较方案二组治疗费用减少724.3元。结论每日或隔日采用300 U·kg^(-1) rhTPO防治肺癌化疗所致CIT总体效果及不良反应差异无统计学意义,但每日用药能更快使PLT升至目标值,而隔日用药能明显减轻患者经济负担。

Objective To investigate the efficacy and cost-effectiveness of different recombinant human thrombopoietin(rhTPO)regimens for the prevention and treatment of chemotherapy-induced thrombocytopenia(CIT)in patients with lung cancer.Methods The clinical data of 73 patients with platelet(PLT)counts under 75×10^(9)·L^(-1) after chemotherapy for lung cancer admitted to the First Affiliated Hospital of Chengdu Medical College from January 2020 to December 2023 were retrospectively analyzed.The patients were divided into the plan 1 group(n=34,300 U·kg^(-1),qod)and the plan 2 group(n=39,300 U·kg^(-1),qd)according to different rhTPO treatment regimens.Then the PLT count,adverse reactions and clinical cost-effectiveness ratio were compared between the two groups.Results PLT values at the 3rd,5th,7th and 10th d of drug administration,and the time taken to rise to 100×10^(9)·L^(-1) yielded no statistical difference between the two groups(P>0.05),and the peak PLT values was(103.7±45.3)×10^(9)·L^(-1) in the plan 1 group and(110.2±41.3)×10^(9)·L^(-1) in the plan 2 group,showing no statistical difference(P>0.05).No statistical difference was reported between two groups in incidence of adverse reactions including leukopenia,anemia and malignant vomiting(70.6%vs 56.4%,29.4%vs 23.1%,23.5%vs 17.9%,χ^(2)=1.269,0.572,0.847,both P>0.05).The total treatment cost and rhTPO cost of the plan 1 group were lower than those of the plan 2 group((11.87±4.09)ten-thousand-yuan vs(13.79±5.23)ten-thousand-yuan,(4236.7±2906.3)yuan vs(6872.4±3673.5)yuan,t=7.154,3.269,both P<0.05).For each unit of improvement in efficacy,the plan 1 group reduced treatment costs by 724.3 yuan as compared with the plan 2 group.Conclusion The efficacy and adverse effects of using 300 U·kg^(-1) rhTPO daily or every other day for the prevention and treatment of chemotherapy-induced CIT in lung cancer are comparable,while the use of rhTPO every other day can significantly reduce the economic burden of patients.