PEG-rhG-CSF用于中、高中性粒细胞减少性发热风险癌症患者一级预防与二级预防的药物经济学评价

Pharmacoeconomic evaluation of primary versus secondary prophylaxis with PEG-rhG-CSF in cancer patients at intermediate-to-high risk of febrile neutropenia

目的评价聚乙二醇化重组人粒细胞集落刺激因子(PEG-rhG-CSF)用于中、高中性粒细胞减少性发热(FN)风险的癌症患者一级预防与二级预防的经济性。方法从中国全社会角度出发,采用TreeAge软件构建决策分析模型。主要状态包括一级预防、二级预防、相对剂量强度≥85%和相对剂量强度<85%。模型参数包括FN发生的风险、FN住院概率、相关癌症死亡概率、相关癌症效用值、直接医疗成本与间接医疗成本等。模型周期为21 d。研究时间范围为70年。主要结果包括总成本、抗感染成本、生命年、质量调整寿命年(QALY)和增量成本效果比。对结果进行了单因素敏感性和概率敏感性分析以评估结果的稳健性;并进行不同时间范围的情景分析。结果基线分析结果显示,与二级预防组相比,一级预防组患者多获得0.84个QALYs,并少支付39373元,节约总的抗感染成本为32311元,增量成本效果比为-46722元/QALY,一级预防组为绝对优势方案。情景分析结果显示,一级预防组与二级预防组相比,在任何研究时间范围都是绝对优势方案。当中国意愿支付阈值为257094元/QALY时,单因素和概率敏感性分析结果显示一级预防组具有成本效果的概率为100%。结论与二级预防相比,PEG-rhG-CSF用于中、高FN风险的癌症患者的一级预防是具有经济性的。

Objective To evaluate the economics of pegylated recombinant human granulocyte colony-stimulating factor(PEG-rhG-CSF)in primary prophylaxis and secondary prophylaxis for cancer patients at intermediate-to-high risk of febrile neutropenia(FN).Methods Decision analysis model was estalished with TreeAge software from the societal perspective in China.The main states included primary prophylaxis,secondary prophylaxis,relative dose intensity(RDI)≥85%,and RDI<85%.Model parameters included the risk of FN,probability of FN hospitalization,cancerrelated death,cancer-related utility value,direct medical cost and indirect medical cost.The model cycle was 21 days,and the simulation lasted 70 years.The primary outcomes included total cost,anti-infection cost,life years,quality-adjusted life-years(QALYs)and incremental cost-effectiveness ratio.One-way and probabilistic sensitivity analyses were conducted to assess the robustness of the results.Scenarios with different time ranges were analyzed.Results The baseline analysis showed that as compared with the secondary prophylaxis group,effectiveness was improved by 0.84 QALYs in the primary prophylaxis group,and the overall costs were reduced by 39373 yuan,saving the anti-infection cost by 32311 yuan.The incremental cost-effectiveness ratio was-46722 yuan/QALY.So the primary prophylaxis was the absolute dominant regimen.In the scenario analysis of different spans,the primary prophylaxis group was superior to the secondary prophylaxis group.The probability of primary prophylaxis group was 100%at willingness-to-pay thresholds of 257094 yuan/QALY.Conclusion Primary prophylaxis with PEG-rhG-CSF is cost-effective as compared with secondary prophylaxis for cancer patients at intermediate-to-high risk of FN.