基于决策树模型抗癌药物试用装的经济学评价

Economic Evaluation of Anticancer Drug Testers Based on Decision Tree Model

目的评价抗癌药物试用装的成本效益。方法构建决策树模型,以在静脉药物配置中心(PIVAS)和普通病房使用抗癌药物试用装为研究策略,在相对应地点不使用抗癌药物试用装为对照策略,比较多西他赛、紫杉醇注射液、注射用奈达铂和利妥昔单抗不同策略的成本效益,采用单因素敏感性分析验证结果的稳健性。结果在我PIVAS配置的紫杉醇、多西他赛、注射用奈达铂和利妥昔单抗试用装净效益分别为-2 948.10、-11 508.80、-4 199.76、14 072.20元,成本效益比为0.40、0.42、0.32、8.42。假设在病房配置紫杉醇、多西他赛、注射用奈达铂和利妥昔单抗试用装净效益分别为165.38、1 248.60、-254.52、15 131.44元,成本效益比为1.09、1.17、0.89、24.78。单因素敏感性分析显示药品价格、配置地点和过敏率是影响敏感率的关键因素。结论过敏率低、价格低廉的药品不适合使用抗癌药物试用装,价格和过敏率较高的紫杉醇和多西他赛可以考虑在病房使用抗癌药物试用装,价格昂贵、过敏率很高的利妥昔单抗可以在PIVAS和病房试用装。

Objective To evaluate the cost-effectiveness of anti-cancer drug testers. Methods A decision tree model was constructed. The use of anti-cancer drug testers in the intravenous drug deployment center(PIVAS) and general wards was the research strategy, and the anti-cancer drug testers were not used in the corresponding locations as the control strategy. Docetaxel, paclitaxel injection, and naphthalene were compared for injection. The cost-effectiveness of the different strategies of daplatin and rituximab was verified by a single-factor sensitivity analysis to verify the robustness of the results. Results The net present value of paclitaxel, docetaxel, nedaplatin and rituximab in PIVAS were-2 948.10,-11 508.80,-4 199.76 and 14 072.20 yuan respectively, and the cost-benefit ratio were 0.40,0.42, 0.32, 8.42. Assuming that the net benefits of paclitaxel, docetaxel, nedaplatin for injection, and rituximab trial installations in the ward are respectively were 165.38, 1 248.60,-254.52 and 15 131.44 yuan respectively, and the cost-benefit ratio were 1.09, 1.17, 0.89 and 24.78. Single factor sensitivity analysis showed that drug price,operating place and allergic reaction rate were the key factors of affacting sensitivity rate. Conclusion Anticancer drug testers should not be used with low allergy rate and low price. Testers of paclitaxel and docetaxel with median price and allergic reaction rate can be used in general ward. Testers of rituximab with high allergic reaction rate and price can be used in PIVAS and wards.