奈达铂联合紫杉醇与顺铂联合紫杉醇治疗晚期非小细胞肺癌的药物经济学评价
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摘要
目的:引入Markov模型评价紫杉醇分别联合奈达铂和顺铂治疗非小细胞肺癌的经济性。方法:建立Markov转移模型,对非小细胞肺癌患者疾病稳定、缓解、进展和死亡状态进行模拟,根据江苏省某医院2015年收费标准、文献所得的转移概率和健康效用值,计算两种一线治疗方案TC(紫杉醇+顺铂)方案和TN(紫杉醇+奈达铂)方案的成本和效用值,建立Markov决策树进行成本效果分析,并对结果进行一维敏感性分析和概率敏感性分析。结果:TC方案化疗两年所需成本为169 586.06元,所获健康效果为0.565质量调整生命年QALY,而TN方案化疗两年所需成本为183 286.39元,所获健康效果为0.595质量调整生命年QALY,一维敏感性分析和概率敏感性分析均显示模型稳定。结论:TN方案与TC方案相比不具有成本效果优势。
Objective: To evaluate the pharmacoeconomics of two first-line therapies(nedaplatin or cisplatin combined with paclitaxel) in the treatment of advanced non-small cell lung cancer(NSCLC) by using a Markov mode. Methods: To calculate the cost and utility of the two first-line therapies, a Markov decision tree model with four states(stable, response, progress and death) was developed via Treeage Pro 11.The therapeutic cost of each treatment cycle was calculated according to standard fees in hospitals of Jiangsu Province. The metastasis probabilities and utilities of health state were estimated based on data from published papers. The Markov decision tree was established and cost-effectiveness analysis was carried out. One way sensitivity analysis and probabilistic sensitivity analysis were conducted to test the stability of the results. Results: The cumulative costs and utilities of the patients receiving TC(paclitaxel+cisplatin)therapy were 169 586.06 yuan and 0.565 quality-adjusted life years gained, respectively; while those of the patients receiving TN(paclitaxel+nedaplatin) therapy were 183 286.39 yuan and 0.595 quality-adjusted life years gained, respectively. The model was proved stable via one way sensitivity analysis and probabilistic sensitivity analysis. Conclusion: The TN therapy is not more cost effective than the TC therapy. Therefore we can hardly decide which therapy is better in the perspective of pharmacoeconomics.
Objective: To evaluate the pharmacoeconomics of two first-line therapies(nedaplatin or cisplatin combined with paclitaxel) in the treatment of advanced non-small cell lung cancer(NSCLC) by using a Markov mode. Methods: To calculate the cost and utility of the two first-line therapies, a Markov decision tree model with four states(stable, response, progress and death) was developed via Treeage Pro 11.The therapeutic cost of each treatment cycle was calculated according to standard fees in hospitals of Jiangsu Province. The metastasis probabilities and utilities of health state were estimated based on data from published papers. The Markov decision tree was established and cost-effectiveness analysis was carried out. One way sensitivity analysis and probabilistic sensitivity analysis were conducted to test the stability of the results. Results: The cumulative costs and utilities of the patients receiving TC(paclitaxel+cisplatin)therapy were 169 586.06 yuan and 0.565 quality-adjusted life years gained, respectively; while those of the patients receiving TN(paclitaxel+nedaplatin) therapy were 183 286.39 yuan and 0.595 quality-adjusted life years gained, respectively. The model was proved stable via one way sensitivity analysis and probabilistic sensitivity analysis. Conclusion: The TN therapy is not more cost effective than the TC therapy. Therefore we can hardly decide which therapy is better in the perspective of pharmacoeconomics.
引文
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[4]罗龙,周天,姚和瑞.含奈达铂与含顺铂化疗方案对晚期非小细胞肺癌疗效与不良反应比较的Meta分析[J].中华临床医师杂志(电子版),2012,6(21):6803-7.
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[6]李明毅,梁颖,黄河,等.紫杉醇联合不同铂类治疗晚期非小细胞肺癌临床研究[J].疑难病杂志,2009,8(8):465-7.
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[8]陈丽昆,徐光川,管忠震,等.奈达铂或顺铂联合紫杉醇治疗晚期非小细胞肺癌的随机对照研究[J].中国肿瘤杂志杂志,2007,29(6):437-40.
[9]邱冬,李杭,姜桂林.奈达铂联合紫杉醇与顺铂联合紫杉醇治疗晚期非小细胞肺癌的随机对照研究[J].临床医药实践,2013,22(8):563-6.
[10]Briggs A,Sculpher M.An introduction to Markov modelling for economic evaluation[J].Pharmacoeconomics,1998,13(4):397-409.
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[13]Nafees B,Stafford M,Gavriel S,et al.Health state utilities for non small cell lung cancer[J].Health Qual Life Outcomes,2008,6:84-98.
[14]黄荣华,马爱霞.转移性结直肠癌的两种一线治疗方案的药物经济学评价[J].中国药物经济学评价,2014,31(2):122-5.
[15]岛崎谦治.日本的医疗---制度与政策[M].南京大学出版社,2016.
[16]Stalpers LJ,Van Gasteren HJ,Van Daal WA.DEALE-ing with life expectancy and mortality rates[J].Med Decis Making,1989,9(2):150-2.
[2]丁婷婷,张晓,高翠,等.非小细胞肺癌患者住院费用影响因素分析及控费研究[J].中国卫生统计,2012,29(2):240-2.
[3]过为,李健华,王峰.奈达铂联合化疗治疗晚期非小细胞肺癌疗效和安全性的Meta分析[J].中国循证医学杂志,2013,3(1):47-54.
[4]罗龙,周天,姚和瑞.含奈达铂与含顺铂化疗方案对晚期非小细胞肺癌疗效与不良反应比较的Meta分析[J].中华临床医师杂志(电子版),2012,6(21):6803-7.
[5]孙超,时会云,袁东朋.紫杉醇联合NDP方案和联合DDP方案治疗非小细胞肺癌的临床疗效观察[J].海南医学,2010,21(11):28-30.
[6]李明毅,梁颖,黄河,等.紫杉醇联合不同铂类治疗晚期非小细胞肺癌临床研究[J].疑难病杂志,2009,8(8):465-7.
[7]孙中义,何执鼎.国产奈达铂联合紫杉醇治疗晚期非小细胞肺癌[J].中国癌症杂志,2006,16(8):679-80.
[8]陈丽昆,徐光川,管忠震,等.奈达铂或顺铂联合紫杉醇治疗晚期非小细胞肺癌的随机对照研究[J].中国肿瘤杂志杂志,2007,29(6):437-40.
[9]邱冬,李杭,姜桂林.奈达铂联合紫杉醇与顺铂联合紫杉醇治疗晚期非小细胞肺癌的随机对照研究[J].临床医药实践,2013,22(8):563-6.
[10]Briggs A,Sculpher M.An introduction to Markov modelling for economic evaluation[J].Pharmacoeconomics,1998,13(4):397-409.
[11]Beck JR,Kassirer JP,Pauker SG.A convenient approximation of life expectancty(The"DEALE").I.Validation of the method[J].Am J Med,1982,73(6)883-8.
[12]Beck JR,Kassirer JP,Pauker SG.A convenient approximation of life expectancty(The"DEALE").II.Use in medical decision-making[J].Am J Med,198273(6):889-97.
[13]Nafees B,Stafford M,Gavriel S,et al.Health state utilities for non small cell lung cancer[J].Health Qual Life Outcomes,2008,6:84-98.
[14]黄荣华,马爱霞.转移性结直肠癌的两种一线治疗方案的药物经济学评价[J].中国药物经济学评价,2014,31(2):122-5.
[15]岛崎谦治.日本的医疗---制度与政策[M].南京大学出版社,2016.
[16]Stalpers LJ,Van Gasteren HJ,Van Daal WA.DEALE-ing with life expectancy and mortality rates[J].Med Decis Making,1989,9(2):150-2.