PT_2N_0M_0乳腺癌治疗方案的成本效果分析  

A cost effective analysis of adjuvant therapy in breast cancers

作　　者：陆劲松[1,2] 沈坤炜[1,2] 沈镇宙[1,2] 韩企夏 邵志敏[1,2] 庄传经 倪鹏生[1,2] 陈大吉 

机构地区：[1]上海医科大学肿瘤医院 [2]上海医科大学公共卫生学院妇幼卫生教研室

出　　处：《中华医院管理杂志》1997年第9期543-545,共3页Chinese Journal of Hospital Administration

摘　　要：目的对区域淋巴结阴性乳腺癌的术后辅助治疗目前存在争议，本研究试从卫生经济学角度为该组患者的临床治疗提供参考。方法选取上海医科大学肿瘤医院１９８８年１月１日至１９９３年１２月１日手术的ＰＴ２Ｎ０Ｍ０的乳腺癌患者共１７２例，按单手术（Ｓ）、术后加三苯氧胺（Ｓ＋Ｔ）、术后加ＣＭＦ辅助化疗（Ｓ＋Ｃ）、术后加三苯氧胺及ＣＭＦ辅助化疗（Ｓ＋Ｔ＋Ｃ）分４组，计算各组５年无瘤生存率（ＤＦＳ）及各组平均每例患者总的费用，后者包括医疗费及误工费。结果Ｓ、Ｓ＋Ｔ、Ｓ＋Ｃ、Ｓ＋Ｔ＋Ｃ４组５年ＤＦＳ分别为９１．３％、９２．９％、８５．９％、８７．８２％（Ｐ＝０．６９１４），而平均每例总费用４组分别为１７７０．４６元、２８１６．８１元、３５２９．５５元、４０８１．９９元（Ｐ＝０．００００）（折算至１９８８年物价水平）。结论无选择性应用术后辅助治疗并不能提高ＰＴ２Ｎ０Ｍ０乳腺癌患者的５年ＤＦＳ及可能的长期生存率，并造成不必要的经济损失及患者生活质量的影响。选择有较高复发危险性的ＰＴ２Ｎ０Ｍ０乳腺癌患者行必要的术后辅助治疗是提高疗效的有效措施。A controversy does exist on the adjuvant treatment for postoperative patients of node negative breast cancer. This analysis tries to offer practical suggestions from the angle of health economics. From Jan.1st, 1988 to Dec.31st,1993. 172 PT 2N 0M 0 breast cancer patients were operated on in the Cancer Hospital of Shanghai Medical School. According to different regimens, they were divided into 4 groups: surgery(S), surgery plus tamoxifen(S+T), surgery plus chemotherapy(S+C), and surgery plus tamoxifen and chemotherapy(S+T+C). The 5 year disease free survival(DFS) and the average cost for each patient(including the loss of working time for the last group) of each group were calculated. The 5 year DFS of the 4 groups were 91 3%,92 9%,85 9%,87 8%(P=0 6914) respectively and the average cost for each patient were 1 770 46, 2 816 81, 3 529 55 and 4 081 99 yuan(P=0 0000) respectively (in terms of 1988 price level). Forthe random PT 2N 0M 0 breast cancer patient, the use of adjuvant treatment does not improve the 5 year DFS compared with those with surgery alone, but only leads to the waste of money and harms the life quality of the patients. So selecting the patients with high risk of relapse for adjuvant treatment should be a more practical way to raise the medical efficiency in the treatment of the node negative breast cancer.

关 键 词：乳腺癌 成本效果分析 外科手术 药物疗法 

分 类 号：R1[医药卫生—公共卫生与预防医学]