艾迪注射液与肝动脉化疗栓塞联合治疗原发性肝癌的成本效果分析
|
摘要
目的从卫生系统角度评估艾迪注射液与肝动脉化疗栓塞(TACE)联合治疗原发性肝癌的成本效果。方法通过文献检索纳入艾迪注射液与TACE联合治疗原发性肝癌的随机对照试验(RCT)的相关文献进行Meta分析,并从卫生服务体系的角度构建药物经济学决策分析模型,模拟艾迪注射液与TACE联合治疗原发性肝癌患者的终身直接医疗成本和质量调整生命年(QALY),评估治疗效果的影响。结果 Meta分析结果显示,与单用TACE比较,艾迪注射液联合TACE方案可提高近期有效率:CR(RR=2.19,95%CI=0.98～4.91,P<0.05),PR(RR=1.32,95%CI=1.12～1.55,P<0.05)。模型分析显示艾迪注射液联合TACE治疗原发性肝癌的人均QALY增加了0.19,平均医疗支出增加了10 403元,增量成本效果比为54 753,<1倍国内人均GDP。结论基于现有文献数据,艾迪注射液联合TACE提高了原发性肝癌患者的期望寿命和生存质量,与单独使用TACE比较,联合使用艾迪注射液在中国具有成本效果优势。今后需要开展更多高质量临床研究以进一步证实艾迪注射液的临床疗效和优势人群。
Objective To evaluate the cost-effectiveness of Aidi injection combined with transcatheter arterial chemoembolization(TACE) in the treatment of primary hepatocellular carcinoma(PHC) from a health system perspective. Methods The meta-analysis of RCT articles on combined treatment of Aidi injection and TACE for PHC was carried out through literature retrieval. Then a pharmacoeconomic decision-making analysis model was constructed from the perspective of health service system to simulate the life-long direct medical cost and quality-adjusted life year(QALY) of PHC patients treated with Aidi injection and TACE, and to evaluate the effect of treatment. Results Meta-analysis showed that compared with TACE alone, Aidi injection combined with TACE could improve the short-term efficiency of CR(RR=2.19, 95% CI=0.98-4.91, P<0.05), PR(RR=1.32, 95% CI=1.12-1.55, P<0.05). The model analysis showed that the quality-adjusted life per capita increased by 0.19 QALY, the average medical expenditure increased by 10 403 yuan, and the incremental cost-effectiveness ratio was 54 753, less than 1 times the GDP per capita in China. Conclusion Based on the existing literature data, Aidi injection combined with TACE improves the life expectancy and quality of life of patients with PHC. Compared with TACE alone, Aidi injection combined with TACE has a very high cost-effectiveness advantage in China. More high-quality clinical studies are needed to further confirm the clinical efficacy and advantageous group of Aidi injection.
Objective To evaluate the cost-effectiveness of Aidi injection combined with transcatheter arterial chemoembolization(TACE) in the treatment of primary hepatocellular carcinoma(PHC) from a health system perspective. Methods The meta-analysis of RCT articles on combined treatment of Aidi injection and TACE for PHC was carried out through literature retrieval. Then a pharmacoeconomic decision-making analysis model was constructed from the perspective of health service system to simulate the life-long direct medical cost and quality-adjusted life year(QALY) of PHC patients treated with Aidi injection and TACE, and to evaluate the effect of treatment. Results Meta-analysis showed that compared with TACE alone, Aidi injection combined with TACE could improve the short-term efficiency of CR(RR=2.19, 95% CI=0.98-4.91, P<0.05), PR(RR=1.32, 95% CI=1.12-1.55, P<0.05). The model analysis showed that the quality-adjusted life per capita increased by 0.19 QALY, the average medical expenditure increased by 10 403 yuan, and the incremental cost-effectiveness ratio was 54 753, less than 1 times the GDP per capita in China. Conclusion Based on the existing literature data, Aidi injection combined with TACE improves the life expectancy and quality of life of patients with PHC. Compared with TACE alone, Aidi injection combined with TACE has a very high cost-effectiveness advantage in China. More high-quality clinical studies are needed to further confirm the clinical efficacy and advantageous group of Aidi injection.
引文
[1] Torre LA,Bray F,Siegel RL,et al.Global cancer statistics,2012[J].CA Cancer J Clin,2015,65(2):87-108.
[2] Chen W,Zheng R,Baade PD,et al.Cancer statistics in China,2015[J].CA Cancer J Clin,2016,66(2):115-132.
[3] Fong ZV,Tanabe KK.The clinical management of hepatocellular carcinoma in the United States,Europe,and Asia:a compre-hensive and evidence-based comparison and review[J].Cancer,2014,120(18):2824-2838.
[4] 中华人民共和国国家卫生和计划生育委员会.原发性肝癌诊疗规范(2017年版) [J].临床肝胆病杂志,2017,33(8):1419-1431.
[5] Lencioni R,de Baere T,Soulen MC,et al.Lipiodoltransarterial chemoembolization for hepatocellular carcinoma:A systematic review of efficacy and safety data[J].Hepatology,2016,64(1):106-116.
[6] Liu J,Wang S,Zhang Y,et al.Traditional Chinese medicine and cancer:History,present situation,and development[J].Thorac Cancer,2015,6(5):561-569.
[7] 龙建安,李叶枚.艾迪与介入化疗联合应用治疗Ⅱ、Ⅲ期原发性肝癌68例观察[J].河北医学,2006,12(3):251-252.
[8] 王彤.中药艾迪联合肝介入化疗治疗老年肝癌疗效观察[J].甘肃中医学院学报,2004,21(3):19-20,35.
[9] 杨玉雪,何璇,文建霞,等.艾迪注射液与肝动脉栓塞化疗联合治疗原发性肝癌的系统评价[J].中国医院用药评价与分析,2016,16(12):1588-1593.
[10] 沈政洁.艾迪注射液治疗原发性肝癌的Meta分析及作用机制研究[D].南京中医药大学,2017.
[11] 国家统计局.中华人民共和国 2017 年国民经济和社会发展统计公报 [EB/OL].2018-02-28:http://www.stats.gov.cn/tjsj/zxfb/201802/t20180228_1585631.html.
[12] 曹海涛,王俊琪,施永兴.五省市注册临终关怀机构晚期恶性肿瘤患者的医疗费用调查 [J].中国全科医学,2010,13(31):3544-3546.
[13] 李仕来,万裴琦,彭涛,等.动脉化疗栓塞术预防肝癌根治性切除术后肿瘤复发的成本效果分析[J].肿瘤防治研究,2015,42(4):350-355.
[14] Thompson Coon J,Hoyle M,Green C,et al.Bevacizumab,sorafenibtosylate,sunitinib and temsirolimus for renal cell carcinoma:a systematic review and economic evaluation[J].Health Technol Assess,2010,14(2):1-184.
[2] Chen W,Zheng R,Baade PD,et al.Cancer statistics in China,2015[J].CA Cancer J Clin,2016,66(2):115-132.
[3] Fong ZV,Tanabe KK.The clinical management of hepatocellular carcinoma in the United States,Europe,and Asia:a compre-hensive and evidence-based comparison and review[J].Cancer,2014,120(18):2824-2838.
[4] 中华人民共和国国家卫生和计划生育委员会.原发性肝癌诊疗规范(2017年版) [J].临床肝胆病杂志,2017,33(8):1419-1431.
[5] Lencioni R,de Baere T,Soulen MC,et al.Lipiodoltransarterial chemoembolization for hepatocellular carcinoma:A systematic review of efficacy and safety data[J].Hepatology,2016,64(1):106-116.
[6] Liu J,Wang S,Zhang Y,et al.Traditional Chinese medicine and cancer:History,present situation,and development[J].Thorac Cancer,2015,6(5):561-569.
[7] 龙建安,李叶枚.艾迪与介入化疗联合应用治疗Ⅱ、Ⅲ期原发性肝癌68例观察[J].河北医学,2006,12(3):251-252.
[8] 王彤.中药艾迪联合肝介入化疗治疗老年肝癌疗效观察[J].甘肃中医学院学报,2004,21(3):19-20,35.
[9] 杨玉雪,何璇,文建霞,等.艾迪注射液与肝动脉栓塞化疗联合治疗原发性肝癌的系统评价[J].中国医院用药评价与分析,2016,16(12):1588-1593.
[10] 沈政洁.艾迪注射液治疗原发性肝癌的Meta分析及作用机制研究[D].南京中医药大学,2017.
[11] 国家统计局.中华人民共和国 2017 年国民经济和社会发展统计公报 [EB/OL].2018-02-28:http://www.stats.gov.cn/tjsj/zxfb/201802/t20180228_1585631.html.
[12] 曹海涛,王俊琪,施永兴.五省市注册临终关怀机构晚期恶性肿瘤患者的医疗费用调查 [J].中国全科医学,2010,13(31):3544-3546.
[13] 李仕来,万裴琦,彭涛,等.动脉化疗栓塞术预防肝癌根治性切除术后肿瘤复发的成本效果分析[J].肿瘤防治研究,2015,42(4):350-355.
[14] Thompson Coon J,Hoyle M,Green C,et al.Bevacizumab,sorafenibtosylate,sunitinib and temsirolimus for renal cell carcinoma:a systematic review and economic evaluation[J].Health Technol Assess,2010,14(2):1-184.