国内晚期非小细胞肺癌4种三代化疗方案的卫生经济学评价

Health economical evaluation of four third-generation chemotherapy regimens in advanced non-small lung cancer patients in China

目的：对国内晚期非小细胞肺癌4种三代化疗方案成本进行比较。方法：利用CDMdisc及CM—CC查找1983-2005年间国内所有符合检索条件的文献，并进行质量评估。检索词：诺维本或长春瑞宾或去甲长春花碱or吉西他宾或健择或泽菲or紫杉醇或紫素或泰素or多西紫杉醇或泰索帝或多帕菲或艾素and顺铂and癌，非小细胞肺，总结上述4种联合方案（分别为NP、GP、PC和DC）的近期疗效、生存期及Ⅲ／Ⅳ度副作用的发生率。建立化疗成本模型，CT（总成本）=C1（化疗药物成本）＋C2（给药成本）＋C3（同时合并药物的成本）＋C4（处理化疗后Ⅲ／Ⅳ度副作用的成本）。利用最小成本分析法和敏感度分析，对4种方案成本进行比较。结果：共检索143篇相关文献，符合条件18篇，721例患者。4种方案有效率分别为47．42％、48．50％、43．28％与46．67％（P〉0．05）。单周期化疗平均成本分别为4322．2RMB（NP）、7420．0RMB（GP）、8113．8RMB（PC）和6372．3RMB（DC），其中C1所占比例分别为61．31％、66．44％、83．49％和70．76％。敏感度分析显示单周期费用不受C2、C3和C4的浮动影响。结论：国内晚期非小细胞肺癌4种三代化疗方案中，NP成本最低，其次为DC、GP，PC成本最高。

Objective： To evaluate and compare the costs of four third-generation chemotherapy regimens in advanced non-small lung cancer （NSCLC） patients in China. Methods： The Chinese biomedical database （CBMdisc） and Chinese Medical Current Contents （CMCC） were used to search for all literature from the year 1983 to 2005 which conformed to the following key words： vinorelbine, gemcitabine, paclitaxel, docetaxel and cisplatin and NSCLC. The corresponding four combination regimens were summarized and compared in response rate, overall survival and 3/4 degrees of adverse effects. Cost-minimization analysis was used according to the following cost model： CT（ total cost） = C1 （chemotherapy） ＋ C2 （drug administration） ＋ C3 （concomitant medication） ＋ C4 （cost for 3/4 degrees of adverse effects）. Sensitivity analyses were performed to quantify the effects of various cost drivers. Results： 18 out of 143 articles were available, and the response rates of the four combination chemotherapies in total for 721 patients were 47. 11%, 48.50%, 43.28% and 37.82% （P 〉0.05） respectively for vinorelbine （NP）, gemcitabine （GP）, paclitaxel （PC）,docetaxel （DC）. Costs per cycle were respectively 4322.2RMB （NP）, 7420. 0 RMB（GP）8113.8RMB（PC） and 6372.3RMB （DC）. C1 covered the largest part in all regimens. Sensitivity analysis presented the conclusion that NP had the lowest cost and was not significantly affected by variance of C2, C3 and C4. Conclusions： Among the four third-generation chemotherapy regimens in NSCLC, NP has the lowest cost, while PC is the most costly. Drug acquisition covers the largest part in all regimens.