转移性结直肠癌3种一线化疗方案的药物经济学评价

Cost-effectiveness analysis of three chemotherapeutic regimens against metastatic colorectal cancer

目的:探讨转移性结直肠癌(mCRC)3种一线化疗方案的药物经济学效果及影响因素。方法:采用回顾性调查方法,纳入2012年1月1日-2015年10月30日期间符合纳入标准的mCRC患者,根据化疗方案不同分为FOLFOX组、CapeOx组和FOLFIRI组。以总住院费用为成本,无进展生存时间(PFS)为效果,对3种化疗方案进行成本-效果分析和敏感度分析,并评价化疗药物是否国产及医保支付对结果的影响。结果:共纳入678名患者,FOLFOX组(136例)、CapeOx组(392例)和FOLFIRI组(150例)间基本情况无统计学差异(P>0.05),具有可比性。FOLFOX组、CapeOx组和FOLFIRI组PFS分别为154.15 d、156.16 d和165.84 d,不良反应各组间无统计学差异,总治疗费用分别为63 956.11元、73 826.06元和79 259.20元,成本-效果比分别为414.90、472.76和477.93。在FOLFOX方案的基础上,每增加一天PFS,FOLFIRI方案和CapeOx方案所追加的成本分别为57.86元和59.69元。敏感度分析结果与成本-效果分析一致。亚组分析表明,国产药物的效果略低于进口药物,成本均高于进口药物,成本-效果比低于进口药物,药物经济学效果好。3种方案患者自付费用成本-效果比FOLFOX方案<CapeOx方案<FOLFIRI方案,医保支付费用成本-效果比FOLFOX<FOLFIRI<CapeOx。结论:mCRC3种一线化疗方案中,成本最低的为FOLFOX方案,效果最佳的为FOLFIRI方案,经济学效果最优为FOLFOX方案。

To assess pharrnacoeconomics and influence factors of three chemotherapeutic regimens in the treat- ment of metastatic colorectal cancer （mCRC）. METHODS From April 1, 2012 to December 30, 2015, mCRC patients, who met inclusion criteria, were retrospectively included in our study, and divided into FOLFOX group, CapeOx group and FOLFI- RI group. The efficacy and costs of the three regimens were collected and analyzed by cost-effectiveness analysis. The effect of chemotherapy drug price and insurance on cost-effectiveness ratio was also analyzed. RESULTS Totally 678 patients were ret- rospectively included, general data of FOLFOX （136）, CapeOx （392） and FOLFIRI （150） group showed no statistical differ- ence （P〈0. 05）. The progression-free survivals （PFS） were 154. 15, 156. 16 and 165. 84 days, the total hospitalization costs were 63 956. 11, 73 826. 06 and 79 259. 20, and the cost-effectiveness ratios were 414. 90, 472. 76 and 477. 93, respectively. The superadditive unit cost of FOLFOX followed by FOLFIRI or CapeOx scheme reached 57. 86 and 59. 69, respectively. Sub- group analysis showed that cost-effectiveness ratio of domestic chemotherapeutics was lower than the imported chemotherapeu- tics. Cost-effectiveness ratio of patients＂ out-of-pocket was FOLFOX〈CapeOx〈FOLFIRI, while cost-effectiveness ratio of pa- tients＂ insurance was FOLFOX〈FOLFIRI〈CapeOx. CONCLUSION FOLFOX chemotherapeutic regimen shows the lowest cost, FOLFIRI chemotherapeutic regimen shows the best efficacy, and FOLFOX chemotherapeutic regimen shows the best Dharmacoeeonomic effect in the first line chemotherapv of mCRC.