晚期非小细胞肺癌两种一线化疗方案的药物经济学评价

Pharmacoeconomic evaluation of two first-line therapies for advanced non-small cell lung cancer

目的对非小细胞肺癌的两种标准一线化疗方案长春瑞滨+顺铂(NP)和吉西他滨+顺铂(GP)进行药物经济学评价,为该病治疗的选择提供决策依据。方法根据WHO实体瘤化疗效果评价标准,确定晚期非小细胞肺癌治疗发展过程分为缓解、稳定、进展、死亡4个状态,构建Markov状态转移模型。根据江苏省某医院化疗的收费标准确定2种非小细胞肺癌一线化疗方案单周期的成本;基于文献数据和DEALE方法原理,估计转移概率;健康效用值采用NAFEES等的研究结果。建立Markov决策树,进行成本效果分析,并对结果进行一维敏感性分析和概率敏感性分析。结果经过健康效用值校正后,NP方案和GP方案化疗2年成本分别为149 761.36元、163 937.76元,所获得的健康效果分别为0.48QALY和0.53.QALY;GP方案与NP方案比较ICER为283 528.00元/QALY。结论 GP方案与NP方案相比ICER大于意愿支付,从成本效果分析,NP方案为优选方案。

AIM To perform a pharmacoeconomic evaluation of two first-line therapies including vinorelbine/cisplatin （NP）, gemcitabine/cisplatin （GP） and to choose a suitable chemotherapy for patients with advanced non-small lung cancer （NSCLC）. METHODS According to the response evaluation criteria in solid tumors of WHO, a Markov decision tree model with four health states which were response, stable, progressive and dead was developed. The direct cost of the NP, GP per treatment cycle was calculated accordingto the charging standard of some hospital of Jiangsu Province. Based on the DEALE method, the transition probabilities in Markov model were estimated from the published randomized controlled clinical trials. The utilities of health states were used the results from Nafees＇ study. The Markov decision tree was used to carry out cost-effectiveness analysis of the two first-line therapies and the one way sensitivity analysis was used to test the stability of the results. And then we developed probabilistic sensitivity analysis using second-order Monte Carlo simulation. RESULTS Adjusted by the health utilities, the total cost of the two first-line therapies NP and GP was ￥149 761.36 and ￥163 937.76, and the total effects were 0.48 QALY and 0.53 QALY. The addition of the GP to NP was estimated with an incremental cost-effectiveness ratio ￥283 528.00 per QALY gained. CONCLUSION The NP is considered to be cost-effective compared with the GP for advanced NSCLC patients.