晚期EGFR突变型非小细胞肺癌患者接受吉非替尼或厄洛替尼治疗的成本效益分析

The Cost-effectiveness Analysis of Gefitinib or Erlotinib in the Treatment of Advanced EGFR Mutant Non-small Cell Lung Cancer Patients

背景与目的非小细胞肺癌(non-small cell lung cancer,NSCLC)靶向治疗越来越受到关注,吉非替尼和厄洛替尼均被推荐用于存在表皮生长因子受体酪氨酸激酶(epidermal growth factor receptor,EGFR)基因突变的晚期NSCLC的一线治疗。本研究旨在分析比较吉非替尼和厄洛替尼在晚期NSCLC的疗效和生存获益,以及治疗成本效益。方法回顾性分析广州医保内的66例EGFR突变型的NSCLC患者。观察疗效和记录不良反应,定期随访生存预后,并追踪治疗费用。结果总共66例可评估患者,中位无进展生存期(progression-free survival,PFS)为15.0个月。其中吉非替尼49例,厄洛替尼17例,PFS分别为17.5个月和13.0个月(P=0.459)。皮疹发生率吉非替尼组为62.3%(31/49),厄洛替尼组为94.1%(16/17)。成本-效益比率(cost-effectiveness ratio,CER)吉非替尼组为3,027元/月,厄洛替尼组为6,800元/月,增量成本-效益比率(incremental cost-effectiveness ratio,ICEA)厄洛替尼为吉非替尼的2.25倍。结论 EGFR突变的晚期NSCLC患者治疗,吉非替尼和厄洛替尼有相似的疗效和生存获益,前者不良反应可能较为轻微。广州医保下,吉非替尼成本-效益比率稍优。

Background and objective Targeted therapy in non-small cell lung cancer （NSCLC） had become a research hotspot. Both ofgefitinib and erlotinib had already been recommended as first line treatment in epidermal growth factor receptor （EGFR） mutant advanced NSCLC patients. The study aimed to compare the effectiveness and prognosis of advanced NSCLC with gefifinib or erlofinib, as well as the cost-effectiveness ratio of the two drugs. Methods Data of 66 EGFR mutant NSCLC patients who were included in Guangzhou medical insurance were analyzed. The efficacy and adverse reactions were evaluated. All the patients were followed-up regularly and the cost of the treatment was recorded. Results The median pro- gression free survival （PFS） of all patients was 15.0 months. 49 patients received gefintib and 17 patients had eflotinib. The PFS for the two groups of patients was 17.5 month and 13 months, respectively （P=0.459）. 31 （62.3%） patients had rash in gefitinib group, 16 （94.1%） in erlotinib group. Cost-effectiveness ratio （CER） in gefitinib group was 3,027 RMB per month, while 6,800 RMB in erlotinib group. The incremental cost-effectiveness ratio （ICEA） of erlotinib was 2.25 times of gefitinib. Conclusion For EGFR mutant advanced NSCLC patients, equal efficacy and survival benefit were observed in patients with gefitinib and erlotinib. The adverse reaction was milder in gefitinib group than that of erlotinib group. And with Guangzhou medical insurance, gefitinib had a superior cost-effectiveness ratio.