Bootstrap法对氟脲嘧啶类药物为基础的联合化疗方案在晚期胃癌中的药物经济学分析

Analysis on the cost-effectiveness of combined chemotherapy composed of fluorouracil drugs for gastric cancer with Bootstrap method

目的:用Bootstrap法对3种以氟脲嘧啶类药物为基础的联合化疗方案在晚期胃癌化疗短期疗效进行药物经济学分析。方法:采用回溯法筛选108例胃癌病例,分成3组,分别为Ⅰ组多西他赛、顺铂联合氟脲嘧啶(DCF)方案,Ⅱ组卡培他滨联合顺铂(XP)方案,Ⅲ组表柔比星、奥沙利铂联合卡培他滨(EOX)方案。比较3组疗效及成本-效果比,用Bootstrap方法分析结果。结果:3组疗效分别为52.78%,47.36%,50.00%。成本-效果比(元/有效率)分别为464.94,451.02,592.54。以成本最低的II组为对照,Ⅰ组和Ⅲ组的增量费用效果比(ICER)分别为586.55,3 131.26。同样以Ⅱ组为对照进行Bootstrap分析,Ⅰ组和Ⅲ组的ICER的平均值分别为557.46,3 285.87,表明敏感性分析结果稳定性好,可信性高。结论:XP方案在疗效的经济获得性方面最优,而在增量费用效果比方面,DCF方案具有积极的经济学意义。

OBJECTIVE To analyze the cosbeffectiveness and evaluate the clinical efficacy of combined chemotherapy com posed of fluorouracil drugs for gastric cancer with Bootstrap method. METHODS 108 patients, who were diagnosed as gastric cancer, were randomly divided into three groups. The group I was DCF given with docetaxel, 5-FU and cisplatin. The group Ⅲ was XP given with capecitabine and eisplatin. The group Ⅲ was EOX given with epirubicin, oxaliplatin and capecitabine.The three groups were assessed by clinical evaluation of pharmacoepidemiology and cost effectiveness analysis of pharmacoeco-nomics. RESULTS The clinical effectiveness of group I , Ⅲ and Ⅲ was 52. 78%,47. 36%,and 50. 00%, respectively. The ratio of cost-effectiveness of group I , II and Ⅲwas 464. 94,451.02, and 592. 54, respectively. Taking the lowest cost group （group Ⅲ ） as the control, the incremental cost-effectiveness ratios （ICER） of group I and HI were calculated. The ICER of and Ⅲgroup was 586. 55,313l. 26. Taking the same group（group Ⅱ ） as the control for Bootstrap analysis, the average val- ue of ICER of I and Ⅲgroup was 557. 46,3285.87, indicating the results of sensitivity analysis with good stability and high credibility. CONCLUSION The XP program in the efficacy of acquired economic aspect is the best. The DCF program has positive significance of economics for the incremental cost effectiveness ratio.