晚期非小细胞肺癌四种化疗方案的最小成本分析

Cost-minimization Analysis of Four Chemotherapy Regimens for Advanced Non-small Cell Lung Cancer

[目的]对比并评价四种化疗方案对晚期非小细胞肺癌的治疗效果、不良反应以及药物经济学。[方法]将60例晚期非小细胞肺癌患者按化疗方案不同分为PC组(紫杉醇+卡铂)、NP组(长春瑞滨+顺铂)、GP组(吉西他滨+顺铂)和TP组(多西他赛+顺铂)。四组均行2个周期化疗且每个周期为21d。观察并对比四种化疗方法的临床疗效和不良反应,运用药物经济学原理对四组进行最小成本分析。[结果]PC、NP、GP和TP四组的总有效率分别为37.5%(6/16)、35.7%(5/14)、40.0%(6/15)和40.0%(6/15),差异无统计学意义(P>0.05);四组消化道综合征、白细胞水平降低、血红蛋白水平降低、血小板计数减少、肝肾功能异常、脱发等不良反应发生率比较差异均无统计学意义(P>0.05);PC、NP、GP和TP组的总成本分别为(5829.9±2184.7)元、(5101.5±1694.0)元、(9310.8±3057.4)元和(6798.7±2409.9)元,四组总成本由高至低为GP组>TP组>PC组>NP组,GP组与其他三组比较差异均具有统计学意义(P<0.05);进行敏感度分析,结果相同。[结论]最小成本分析显示采用TP、PC、NP方案治疗晚期非小细胞肺癌疗效相当,可最大限度提高药物资源在临床的利用和配置的效率。

[Purpose] To compare and evaluate the clinical efficacy,adverse reaction and pharmacoeconomic effect of four kinds of chemotherapy regimens on treatment of non-small cell lung cancer（NSCLC）. [Methods] According to the different chemotherapy regimen,60 cases hospitalized patients with NSCLC were divided into PC group（paclitaxel and carboplatin）,NP group（vinorelbine and cisplatin）,GP group（gemcitabine and cisplatin） and TP group（docetaxel and cisplatin）. Each group was undergone two cycles of chemotherapy whose period was 21 days. The clinical efficacy and adverse reaction of four kinds of chemotherapy regimens were observed and compared,and the cost-minimization was analyzed by pharmacoeconomic theory.[Results] The total efficiency of the PC group,NP group,GP group and TP group were 37.5%（6/16）,35.7%（5/14）,40.0%（6/15） and 40.0%（6/15）,respectively. There was no statistical difference in four groups（P〉0.05）. The adverse reaction in four groups were gastrointestinal syndrome,lower white blood cell level,lower hemoglobin levels,lower platelet count,liver and kidney dysfunction and alopecia,and all the incidence of adverse reactions of four groups had no significant difference（ P〉0. 05）. The costs of PC group, NP group, GP group and TP group were5829.9±2184.7 yuan,5101.5±1694.0 yuan,9310.8 ±3057.4 yuan and 6798.7 ±2409.9 yuan,respectively. The costs of four groups from high to low were GP group,TP group,PC group and NP group. The differences between GP group compared with other three groups was statistically significant（P〉0.05）. After the sensitivity analysis,the results were still the same. [Conclusions]The cost-minimization shows that the chemotherapy methods in TP group,PC group and GP group have the same clinical efficacies. They can improve the utilization and allocation efficien-cy of pharmaceutical resources in clinical to the maximum extent.