两种化疗方案治疗初治多发性骨髓瘤的成本-效果分析

Cost-effectiveness Analysis of Two Chemotherapy Regimens in the Treatment of Initially Diagnosed Multiple Myeloma

目的:评价两种化疗方案治疗多发性骨髓瘤(MM)的成本与效果。方法:回顾性分析我院63例无干细胞移植条件的初治MM患者,按不同化疗方案分为两组,其中MPT组(采用马法兰+强的松+沙利度胺方案)患者41例,VDT组(采用硼替佐米+地塞米松+沙利度胺方案)患者22例。观察两组患者的临床疗效、生存时间及不良反应,并进行成本-效果分析。结果:(1)MPT组患者总反应率为63.4%,VDT组为77.3%,差异无统计学意义(P=0.260);MPT组患者完全缓解率为12.2%,VDT组为36.4%,差异有统计学意义(P=0.024)。(2)MPT组患者中位无进展生存期为(14.314±0.488)月,VDT组为(18.557±0.848)月,差异有统计学意义(P<0.001);MPT组患者的中位总生存时间为(33.536±1.143)月,VDT组为(41.048±1.868)月,差异有统计学意义(P=0.007)。(3)白细胞减少、恶心呕吐和周围神经毒性发生率VDT组患者均高于MPT组,差异有统计学意义(P<0.05)。(4)MPT组成本-效果比为247.48,VDT组为2 922.77,两者增量成本-效果比为15 125.18;敏感度分析结果与该结果相符。结论:VDT方案的临床疗效及生存时间较MPT方案好,但MPT方案的成本-效果及不良反应发生率优于VDT方案,更适合无干细胞移植条件、经济条件差的MM患者。

OBJECTIVE：To evaluate the cost and effectiveness of two chemotherapy regimens in the treatment of initially diagnosed multiple myeloma（MM）. METHODS：63 patients who were newly diagnosed as MM without transplant chance in our hospital were analyzed retrospectively,and then divided into MPT group（alkeran ＋ metacortandracin ＋ thalidomide,41 cases） and VDT group（bortezomib ＋dexamethasone＋thalidomide,22 cases）according to chemotherapy regimens. Clinical efficacy,survival time and ADR of 2 groups were observed,and cost-effectiveness analysis of them were conducted. RESULTS：The overall response rates of MPT group and VDT group were 63.4% and 77.3%,respectively（P=0.260）;the complete response rate of them were 12.2% and 36.4%,with statistical difference（P=0.024）. The progression free survival of MPT group and VDT group were（14.314±0.488）months and（18.557±0.848）months,with statistical significance（P〈0.001）;the overall survival of MPT group and VDT group were（33.536±1.143）months and（41.048±1.868）months,with statistical significance（P=0.007）. Leukocytopenia,nausea and vomit and peripheral neurotoxicity of VDT group were both higher than those of MPT group,with statistical significance（P〈0.05）. The cost-effectiveness ratio of MPT group was 247.48,and that of VDT group was 2 922.77;the incremental cost-effectiveness ratio was 15 125.18. The results were consistent with the sensitivity test. CONCLUSIONS：Clinical efficacy and survival time of VDT regimen is better than that of MPT regimen,but MPT regimen is superior to VDT regimen in respect of cost-effectiveness analysis and the incidence of ADR. which will more suitable for the MM patients without transplant chance or goood economic conditions.