FAM、EAP、ELF方案治疗胃癌的成本和效果对照

Cost-effectiveness analysis of three chemotherapy regimens for treatment of gastric cancer

目的:探讨FAM、EAP、ELF方案治疗胃癌的成本和效果.方法:选取2012-06/2014-05厦门大学附属第一医院收治的胃癌住院患者64例,按照化疗方案不同分成3组,FAM组采用5-氟尿嘧啶(5-fluorouracil,5-Fu)+阿霉素(adriamycin,ADM)+丝裂霉素(mitomycin,MMC)治疗,EAP组采用表鬼臼毒甙(etoposide,VP-16)+ADM+顺铂(cisplatin,PDD)治疗,ELF组VP-16+甲酰四氢叶酸(leucovorin,LV)+5-Fu治疗,采用药物经济学成本效果分析法对3种化疗方案进行评价.结果:FAM、EAP、ELF 3组化疗总有效率分别为45.8%、54.5%、50.0%,比较差异无统计学意义(P>0.05);3组中位生存期分别为7、8、9 mo,比较差异无统计学意义(P>0.05);1个周期人均药物费用分别为7689元、6388元、10250元,EAP组明显低于FAM组和ELF组(P<0.05);化疗总有效率每增加1个百分点所需费用分别为167.88元、117.21元、205.00元,中位生存期每增加1 mo成本分别为1281.50元、912.50元、1281.25元,EAP组明显低于FAM组和ELF组(P<0.05).结论:治疗胃癌的FAM、EAP、ELF方案中成本-效果由低到高依次为EAP<FAM<ELF,临床上EAP为最适合治疗胃癌的化疗方案.

AIM： To compare the costs and effects of three chemotherapy regimens in the treatment of gastric cancer. METHODS： From June 2012 to May 2014, 64 patients with gastric cancer were divided intothree groups and given different chemotherapy regimens, namely, 5-fluorouracil （5-Fu） combined with adriarnycin （ADM） and mitomycin （MMC） （FAM group）, etoposide （VP-16） combined with ADM and cisplatin （PDD） （EAP group）, and VP-16 combined with leucovorin （LV） and 5-Fu （ELF group）. Pharmacoeconomic cost- effectiveness analysis of the three chemotherapy regimens was performed. RESULTS： The total effective rates for the FAM, EAP and ELF groups were 45.8%, 54.5% and 50.0%, respectively, which did not differ significantly among the three groups （P 〉 0.05）. The median survival time of the three groups were 7, 8, and 9 mo, respectively, which also did not differ significantly among the three groups （P 〉 0.05）. The per capita drug cost in one cycle was significantly lower in the EAP group than in the FAM and ELF groups （6388 yuan vs 7689 yuan, 10250 yuan, P 〈 0.05）. The cost for each additional 1 percent of total effective rate （117.21 yuan vs 167.88 yuan, 205 yuan, P 〈 0.05） and the cost for each additional 1 mo of the median survival time （912.50 yuan vs 1281.50 yuan, 1281.25 yuan, P 〈 0.05） were significantly lower in the EAP group than in the FAM and ELF groups. CONCLUSION： The cost-effectiveness of the three regimens for gastric cancer in an ascending order is EAP 〈 FAM 〈 ELF. EAP is the most suitable regimen for the treatment of gastric cancer.