硫培非格司亭与重组人粒细胞刺激因子用于预防乳腺癌患者化疗相关中性粒细胞减少的成本-效用分析

Cost-effectiveness Analysis of Thiopentyl and Recombinant Human Granulocyte Stimulating Factor in Preventing Decrease of Related Neutropenia in Chemotherapy in Breast Cancer Patients

目的评价硫培非格司亭注射液与重组人粒细胞刺激因子注射液用于预防乳腺癌患者化疗引起的中性粒细胞减少症的成本-效用。方法从支付角度出发,采用Markov模型,对硫培非格司亭和重组人粒细胞刺激因子两种预防乳腺癌患者化疗引起中性粒细胞减少的治疗方案进行成本-效用分析。临床效果参数和效用参数源于硫培非格司亭乳腺癌的Ⅲ期临床试验数据和国内外参考文献,成本费用来源于医疗机构抽样数据。结果指标包括成本、质量调整生命年(QALYs)和增量成本-效用比(ICER)。采用单因素和概率敏感性分析对结果进一步分析,以评估模型结果的稳定性。结果基础分析结果显示硫培非格司亭组平均治疗成本为35 019.35元,QALYs为9.99年,重组人粒细胞刺激因子组平均治疗成本为39 586.24元,QALYs为9.75年。单因素敏感性分析显示结果具有稳定性。概率敏感性分析结果显示,当支付意愿为1倍人均GDP时,硫培非格司亭组具有经济学的概率在90%以上。结论硫培非格司亭与重组人粒细胞刺激因子比较用于预防乳腺癌患者化疗引起的中性粒细胞减少症,不仅可减少升白周期费用,更可提高疗效,降低感染和RDI治疗成本,具有绝对经济学优势。

Objective To eveluate the cost-effectiveness of mecapegfilgrastim injection and recombinant human granulocyte stimulating factor injection for preventing chemotherapy-induced neutropenia in breast cancer patients. Methods From the perspective of payment, using the Markov model, cost-utility analysis was performed on 2 treatment regimens for chemotherapy-induced neutropenia in patients with breast cancer who were treated with thiopentestatin and recombinant human granulocyte-stimulating factor. The clinical effect parameters and utility parameters were derived from the phase III clinical trial data of mecapegfilgrastim breast cancer and domestic and foreign references. The cost was derived from the sampling data of medical institutions. Outcome measures included cost, quality adjusted life years(QALYs) and incremental cost-effectiveness ratio(ICER). Single factor and sensitivity analysis was conducted to assess the reliability of the model. Results The basic analysis showed that the average cost in the mecapegfilgrastim group was 35019.35 yuan, with QALYs of 9.99 years, while the average cost in the recombinant human granulocyte stimulating factor group was 39 586.24 yuan, with QALYs of 9.75 years. One-way sensitivity analysis showed that the result was stable. Probabilistic sensitivity analyses indicated that when the willingness to pay is 1 times the GDP per capita, the probability of economics of the mecapegfilgrastim group is above 90%. Conclusion Compared with recombinant human granulocyte stimulator, thiopenigastine has absolute economic advantages in preventing neutropenia caused by chemotherapy in breast cancer patients. It can not only reduce the cost of leukopenia cycle, but also improve the curative effect and reduce the cost of infection and RDI treatment.