评价两种一线化疗方案在表皮生长因子受体突变的晚期非小细胞肺癌患者的成本-效果

Cost-effectiveness evaluation of two first-line chemotherapy regimens in advanced non-small cell lung cancer patients with epidermal growth factor receptor mutation

目的评价表皮生长因子受体突变的晚期非小细胞肺癌一线化疗方案厄洛替尼和吉西他滨+卡铂的成本-效果。方法根据疾病进展情况,确定晚期非小细胞肺癌治疗发展过程分为无进展、进展和死亡3个状态,建立Markov状态转移模型。根据文献资料和当地医院的收费标准确定两种非小细胞肺癌一线化疗方案单周期的成本和效用值;运用R语言估算转移概率。建立Markov决策树进行成本-效果分析,并对结果进行一元敏感度分析和概率敏感度分析。结果厄洛替尼和吉西他滨+卡铂10年的成本分别为202 873.56元和369 632.11元,所获得的健康效果分别为1.35质量调整生命年和1.94质量调整生命年,厄洛替尼与吉西他滨+卡铂比较,增量成本效果比为-279 797.55元/质量调整生命年。结论厄洛替尼方案与吉西他滨+卡铂方案相比增量成本效果比小于意愿支付值,从成本-效果分析角度,厄洛替尼方案为优选方案。

AIM To estimate the cost- effectiveness of two first- line chemotherapies including erlotinib and gemcitabine ＋ cisplatin（ GC） for advanced non- small cell lung cancer patients with mutated epidermal growth factor receptor. METHODS A Markov model with three health states which were progression- free survival, progression survival and die was built based on the natural history of advanced non- small cell lung cancer. The direct cost and utilities of erlotinib and GC per cycle were calculated according to the charging of local hospital and literature, and the transition probabilities in Markov model were estimated by R language. The Markov decision tree was used to carry out cost- effectiveness analysis of the two therapies. The one- way and probability sensitivity analysis were used to test the stability of the results. RESULTS According to the model,the ten year cost of the erlotinib and GC were 202 873.56 yuan and 369 632.11 yuan, and the effects were1.35 QALYs and 1.94 QALYs. The addition of erlotinib to GC was estimated with an incremental cost- effectiveness ratio-279 797.55 yuan/QALY. CONCLUSION The erlotinib is considered to be cost- effective compared with GC for advanced non- small cell lung cancer patients with mutated epidermal growth factor receptor.