吉非替尼在表皮生长因子受体突变的晚期非小细胞肺癌患者一线化疗中的成本-效果性分析  

Cost-effectiveness of gefitinib as first-line therapy for advanced non-squamous-cell lung cancer patients with sensitive mutations of the epidermal growth factor receptor(EGFR)

作　　者：赵子影[1,2] 彭六保[1] 李健和[1] 曾小慧[1,2] 欧阳丽辉[1,2] 王思颖[1,2] 

机构地区：[1]中南大学湘雅二医院药学部,湖南长沙410011 [2]中南大学药学院,湖南长沙410013

出　　处：《中国医院药学杂志》2013年第22期1853-1857,共5页Chinese Journal of Hospital Pharmacy

基　　金：国家自然科学项目(基金编号:81173028)

摘　　要：目的:从医疗卫生角度出发,评价一线吉非替尼化疗在表皮生长因子受体突变的晚期非小细胞肺癌患者中的成本效果性。方法:根据晚期肺癌患者疾病发展情况建立Markov模型,将模型分为无进展状态、进展状态和死亡状态,计算增量成本效果比。用敏感度分析验证模型稳定性。结果:根据模型运行结果,相对于标准化疗组,吉非替尼组的增量成本效果比为-13.499.7元/质量调整生命年。PFS状态的效用值对结果的影响最大,其次是吉非替尼的成本及紫杉醇的单位成本,其他参数对模型影响较小。概率敏感度分析显示,意愿支付阈值为111 173.9元时,吉非替尼具有成本效果性的概率为90%。敏感度分析结果显示模型结构稳定,研究结果可靠。结论:EGFR突变的晚期非小细胞肺癌患者一线化疗使用吉非替尼具有较佳的成本效果性。OBJECTIVE From the perspective of the Chinese Health Care System, to evaluate the cost-effectiveness of gifitinib in patients with advanced non-small-cell lung cancer with mutated EGFR. METHODS A Markov model was built based on the natural history of advanced non-small-cell lung cancer, which was composed of three mutually exclusive health states：Progression-Free Survival, Progressed Survival and Die, were used to estimate the incremental cost-effectiveness ratio. The model was rolled back on TreeAge Pro Suite 2009. Sensitivity analysis was performed to assess the stability of the model. RESULTS According to the model result, compared with chemotherapy arm, the incremental cost-effectiveness ratio of gifitinib was -13. 499. 7 Yuan per quality adjusted life-year gained. The utility in PFS had a remarkable influence on the results, following by the unit costs of gefitinib and paclitaxel,other parameters had little influence. Probability sensitiv4ty analysis showed that the probability of gefitinib being cost-effectiveness was 90. 0% at the willingness to pay of 111 173.9 Yuan. The results were robust to key parameters in sensitivity analysis. CONCLUSION The results show that gefitinib as first-line treatment might be a cost-effective option in advanced non-small cell lung cancer with mutated EGFR, from the perspective of Chinese Health Care System.

关 键 词：吉非替尼 成本效果 非小细胞肺癌 敏感度分析 

分 类 号：R956[医药卫生—药学]