吉西他滨或氟尿嘧啶联合顺铂治疗晚期鼻咽癌的药物经济学评价

Pharmacoeconomic Evaluation of Gemcitabine or Fluorouracil Combined with Cisplatin in the Treatment of Advanced Nasopharyngeal Carcinoma

目的从中国医疗卫生角度,对晚期鼻咽癌患者吉西他滨联合顺铂(GP)与氟尿嘧啶联合顺铂(FP)治疗方案进行药物经济学研究。方法根据某大型三期临床试验研究结果,建立Markov模型,将模型分为3个互相排斥的状态,评价GP与FP方案治疗晚期鼻咽癌患者的成本效果,并对结果进行一元敏感度分析和概率敏感度分析。结果接受GP方案治疗的晚期鼻咽癌患者与FP方案相比,延长0.3质量调整生命年(QALYs),但费用增加34292.68元,使用增量成本效果比(ICER)为98180.97元/QALYs,低于我国意愿支付值(WTP)193932元/QALYs,GP方案具有成本效果优势。结论模型研究结果显示,在晚期鼻咽癌患者的治疗中,与FP方案相比,GP方案具有成本效果优势。

Objective To evaluate the cost-effectiveness of gemcitabine plus cisplatin(GP)vs fluorouracil plus cisplatin(FP)in the treatment of advanced nasopharyngeal carcinoma patients from the perspective of Chinese medical and health system.Methods Based on the outcome from a phase III randomized clinical trial,a Markov model was developed to compare the cost and effectiveness of gemcitabine plus cisplatin vs fluorouracil plus cisplatin in the treatment of advanced nasopharyngeal carcinoma.And one-way sensitivity analyses and probabilistic sensitivity analyses were performed to evaluate the uncertainty of the model.Results Compared with FP regimen,GP regimen prolonged 0.3 quality adjusted life years(QALYs),but increased the cost by 34292.68 yuan.The incremental cost-effectiveness ratio(ICER)was 98180.97 yuan/QALYs,which was lower than the WTP value of 193932 yuan/QALYs in China.Thus,GP regimen is cost-effective.Conclusion Gemcitabine plus cisplatin regimen was estimated to be more cost-effective than fluorouracil plus cisplatin regimen for advanced nasopharyngeal carcinoma based on the results of the model.