转移性结直肠癌二线化疗方案的成本-效果分析

Cost-Effectivness Analysis of Second-Line Chemotherapy Therapies For Metastatic Colorectal Cancer

目的探讨对转移性结直肠癌患者6种常用二线化疗方案的成本-效果。方法纳入的二线化疗方案包括雷替曲塞类方案:雷替曲塞+奥沙利铂(RALOX)或雷替曲塞+伊立替康(RALIRI);卡培他滨类方案:卡培他滨+奥沙利铂(CAPOX)或卡培他滨+伊立替康(CAPIRI);氟尿嘧啶类方案:氟尿嘧啶/亚叶酸钙+奥沙利铂(FOLFOX)或氟尿嘧啶/亚叶酸钙+伊立替康(FOLFIRI)。从医疗保建系统角度出发,以接受上述二线化疗方案的转移性结直肠癌患者为研究对象并进行成本-效果分析。成本为不同化疗方案的次均住院费用,来源于医保和医院数据;效果为总生存时间(OS),来源于中英文数据库中的各方案临床随机对照试验。对结果进行单因素敏感性分析。结果与成本最小的CAPOX方案(成本为47 256元,效果OS为0.88年)相比,CAPIRI方案(成本为50 204元,效果OS为0.80年)费用更高,效果更差。与成本最小的CAPOX方案比较,RALOX方案(成本为53 852元,效果OS为1.13年)的增量成本效果比ICER方案为26 384元/QALYs。根据WHO建议的3倍人均GDP标准,中国当前的人均年生命价值大于12万,RALOX方案增量成本小于人均1年生命价值,RALOX方案具有成本-效果。FOLFOX方案(成本为58 056元,效果OS为1.02年)、RALIRI方案(成本为63 152元,效果OS为0.99年)、FOLFIRI方案(成本为64 612元,效果OS为0.96年)与RALOX方案相比,费用更高,效果更差。结论相较于氟尿嘧啶类方案,以RALOX方案为二线化疗方案治疗转移性结直肠癌的优势方案;与卡培他滨类方案相比,RALOX方案的成本-效果更高。上述结论对医保支付具有参考价值。

Objective The purpose of this study was to conduct a cost-effectiveness analysis of second-line chemotherapy therapies for metastatic colorectal cancer（m CRC）.Methods The second-line chemotherapy therapies includes RALOX/RALIRI/ CAPOX/CAPIRI/FOLFOX/FOLFIRI in m CRC from the perspective of China health care system.Effectiveness data were extracted from randomized clinical trials.Costs were obtained from medical insurance database and inpatient care data.The robustness of the result was evaluated by one-way sensitivity analyses.Results CAPIRI was not cost-effective compared with CAPOX.RALOX was compared to CAPOX with an ICER estimated at$26,384 per overall survival year.RALOX was cost-effective compared to CAPOX with an ICER at$26,384 per overall survival year,which was smaller than the cost of per year of life saved.FOLFOX/RALIRI/FOLFIRI were not costeffective compared with RALOX.Conclusion RALOX is the most cost-effective second line therapy for m CRC,and thus RALOX is the optimal option in the treatment of m CRC.