治疗转移性结直肠癌的两种一线化疗方案的药物经济学评价

Pharmacoeconomic evaluation of two first-line chemotherapy regimens for metastatic colorectal cancer

目的对FOLFOX方案与XELOX方案一线化疗治疗转移性结直肠癌的药物经济学进行评价。方法 100例远处转移性结直肠癌患者作为研究对象,按照治疗方案的不同分为FOLFOX组和XELOX组,每组50例。FOLFOX组患者予以5-氟尿嘧啶(5-Fu)+亚叶酸钙+奥沙利铂进行化疗,XELOX组患者予以卡培他滨+奥沙利铂进行化疗。评价比较两组患者的临床疗效、不良反应发生情况,并对成本(C)-效果(E)进行分析。结果 100例患者的疗效均可评价。FOLFOX组患者的总缓解率为62.0%(31/50),明显高于XELOX组的40.0%(20/50),差异有统计学意义(χ2=4.842, P=0.028<0.05)。FOLFOX组患者治疗后的胃肠道反应Ⅰ～Ⅱ度、Ⅲ～Ⅳ度及骨髓抑制Ⅰ～Ⅱ度例数均明显多于XELOX组,差异均有统计学意义(P<0.05)。经成本-效果分析, XELOX组患者的C/E为579.91, FOLFOX组患者的C/E为248.77, XELOX组患者的治疗成本高于FOLFOX组。结论采用FOLFOX方案对转移性结直肠癌进行一线化疗具有较低的成本以及相对较好的疗效,但其不良反应的发生率相对较高,采用此方案治疗的患者临床需承受更多疼痛与不便。虽然XELOX方案的成本比FOLFOX方案高,但不良反应的发生率相对较低。两种一线化疗方案各有优劣,临床可结合患者的实际病情进行选择治疗。

Objective To evaluate the pharmacoeconomics of two first-line chemotherapy regimens for metastatic colorectal cancer. Methods A totalof 100 patients with distant metastatic colorectal cancer as study subjects were divided by different treatment regimens into FOLFOX group and XELOX group, with 50 cases in each group. FOLFOX group received 5-fluorouracil (5-Fu)+ calcium folinate+oxaliplatin for chemotherapy, and XELOX group received capecitabine+oxaliplatin for chemotherapy. The clinical efficacy and occurrence of adverse reactions of the two groups were evaluated and compared, and the cost (C)- effect (E) was analyzed. Results The efficacy of 100 patients can be evaluated. FOLFOX group had obviously higher total remission rate as 62.0%(31/50) than 40.0%(20/50) in XELOX group, and the difference was statistically significant (χ^2=4.842, P=0.028<0.05). The number of gastrointestinal reactions Ⅰ~Ⅱ degree,Ⅲ~Ⅳ degree and myelosuppressive Ⅰ~Ⅱ degree in FOLFOX group were significantly higher than those in XELOX group, and the difference was statistically significant (P<0.05). After cost-effectiveness analysis, the C/E of the patients in the XELOX group was 579.91, and the C/E of the patients in the FOLFOX group was 248.77. The treatment cost of XELOX group was higher than that of FOLFOX group. Conclusion FOLFOX regimen for first-line chemotherapy of metastatic colorectal cancer has low cost and relatively good efficacy, but the incidence of adverse reactions is relatively high. Patients treated with FOLFOX regimen need to bear more pain and inconvenience. Although the cost of XELOX is higher than that of FOLFOX, the incidence of adverse reactions is relatively low. The two first-line chemotherapy schemes have their own advantages and disadvantages. Clinical treatment can be selected according to the actual condition of patients.