诊断相关分组付费下奈妥匹坦/帕洛诺司琼用于预防卡铂化疗相关性恶心呕吐的药物经济学评价

Pharmacoeconomic evaluations of netupiptant/palonosetron in preventing carboplatin chemotherapy-related nausea and vomiting under diagnosis-related group payment

目的:为奈妥匹坦/帕洛诺司琼预防化疗所致恶心呕吐及医院诊断相关分组(DRG)药物精细化管理提供参考。方法:选取医保结算时间为2022年5月1日至2023年2月28日江苏省肿瘤医院收治的入组分组编码RE13(恶性增生性疾患的化学治疗和/或其他治疗,伴并发症或合并症)和RG13(恶行增生性疾患的靶向、免疫治疗,伴并发症或合并症)的病例164例,A组使用福沙匹坦双葡甲胺、帕洛诺司琼、地塞米松进行预防(128例)卡铂化疗相关性恶心呕吐,B组使用奈妥匹坦/帕洛诺司琼、地塞米松进行预防(36例)。对2组预防方案进行药物经济学评价,并进行敏感性分析。结果:A组和B组的临床疗效和不良反应比较,差异均无统计学意义(P>0.05)。A组和B组预防方案的成本分别为2017.911元和1575.751元,B组预防方案更经济,敏感性分析支持上述结果。结论:“奈妥匹坦/帕洛诺司琼+地塞米松”和“福沙匹坦+帕洛诺司琼+地塞米松”预防卡铂化疗相关性恶心呕吐的有效性及安全性相当,前者的经济性稍优于后者,但后者可用于吞咽困难等不能口服药物止吐的患者。

OBJECTIVE To provide references for rational use of netupitant/palonosetron in chemotherapy-induced nausea and vomiting(CINV)and implement refined in-hospital management of diagnosis-related group(DRG)drugs.METHODS From May 1,2022 to February 28,2023,164 cases were enrolled at Jiangsu Cancer Hospital with a code of RE13(chemotherapy and/or other treatments for malignant proliferative diseases with concurrent conditions or complications)and RG13(targeting and immunotherapy for malignant proliferative diseases with concurrent conditions or complications).Group A received fosaprepitant dimeglumine,palonosetron and dexamethasone(n=128)while Group B was subjected to a prophylactic regimen of netupitant/palonosetron and dexamethasone(n=36).Clinical efficacy and adverse reactions were compared,treatment expenses calculated and pharmacoeconomic evaluations conducted for two treatment protocols.And sensitivity analysis was performed simultaneously.RESULTS No statistically significant inter-group difference existed in clinical efficacy or adverse reactions(P>0.05).The expenses of groups A and B were 2017.911 and 1575.751 yuan respectively.Treatment protocol was more economical for group B.The above conclusion was supported by the results of sensitivity analysis.CONCLUSION“Netupitant/palonosetron plus dexamethasone”and“fosaprepitant plus palonosetron plus dexamethasone”offer comparable efficacy and safety in the prevention of carboplatin CINV.The former is more cost-effective than the latter.It is indicated for patients with dysphagia unsuitable for oral antiemetics.To provide references for rational use of netupitant/palonosetron in chemotherapy-induced nausea and vomiting(CINV)and implement refined in-hospital management of diagnosis-related group(DRG)drugs.