恶性胸膜间皮瘤药物经济学评估

Pharmacoeconomics Evaluation of Malignant Pleural Mesothelioma

目的：在中国的医疗实践情况下,评价培美曲塞二钠联合顺铂治疗恶性胸膜间皮瘤与单独使用顺铂治疗相比的成本效果（经济性）。方法：本研究基于III期临床研究EMPHACIS,进行回顾性药物经济学评价。疗效数据来源于EMPHACIS试验,药物成本、化疗成本和不良反应成本等成本数据均根据我国的成本标准进行核算。在成本效果和成本效用分析后,采用培美曲塞二钠的最高价和最低价进行敏感度分析。结果：培美曲塞二钠联合顺铂的总成本约为$56421.63~58049.93元。培美曲塞二钠联合顺铂治疗与单用顺铂相比,每多获得1年生存期的增量成本在$127102.3~212514.8之间。每多获得1个QALY的增量成本在$218957.7~360542.3之间。研究结果受培美曲塞二钠价格的影响比较大。结论：对所有的患者而言,培美曲塞二钠联合顺铂并不具有成本效果性。相比而言,培美曲塞二钠更适合晚期且功能状态好的恶性胸膜间皮瘤患者。另外,国产培美曲塞二钠具有成本效果。

Objective： To evaluate the cost-effectiveness/utility of pemetrexed plus cisplatin therapy versus cisplatin monotherapy in patients with malignant pleural mesothelioma（MPM） in China clinical practice. Methods：The retrospective pharmacoeconomic analysis was developed based on the largest phase III trial（EMPHACIS） in patients with MPM. The efficacy came from the EMPHACIS. The costs including pharmacy costs, chemotherapy costs and drug-related adverse events were calculated according to Chinese prices. Besides the cost-effectiveness/utility analysis, the one-way sensitive analysis was developed using ceiling price and minimum price of pemetrexed. Results： The total pemetrexed plus cisplatin cost per patient varied between $56 421.63 and 58 049.93. Incremental cost per life-year gained ranged from $127 102 to 212 514.8,and incremental cost per quality-adjusted life-year was $218 957.7～360 542.3. The price of pemetrexed had a great influence on results. Conclusion： Pemetrexed was unlikely to be considered cost-effective for all the patients. These findings were better for fully supplemented patients with good performance status and advanced diseases. In addition, domestic pemetrexed is more likely to be cost effective.