硼替佐米治疗多发性骨髓瘤的药物经济学分析  

Pharmacoeconomic Analysis of Bortezomib in the Treatment of Multiple Myeloma

作　　者：杨中婷 张慧[2] 黄源 YANG Zhong-Ting;ZHANG Hui;HUANG Yuan(School of Public Health,Kunming Medical University,Kunming 650504,China;School of Public Health,Sun Yat-sen University,Guangzhou 510080,China)

机构地区：[1]昆明医科大学公共卫生学院,昆明650504 [2]中山大学公共卫生学院,广州510080

出　　处：《中国药物经济学》2022年第4期5-9,共5页China Journal of Pharmaceutical Economics

基　　金：国家自然科学基金项目(71704194);美国中华医学基金会CMB-OC项目(19-339)。

摘　　要：目的探讨硼替佐米治疗多发性骨髓瘤(MM)的成本-效果/效用,为治疗MM提供决策依据。方法收集2008—2013年广州市某两家三甲医院155例MM患者达到治疗平台期的治疗成本和临床疗效数据,并检索文献中报道的MM患者生存时间和效用值,估计单纯/联合化疗使用硼替佐米与传统化疗治疗MM的成本-效果/效用,并对结果进行敏感性分析。结果硼替佐米组(78例,150218.32元)到达平台期的人均费用高于传统化疗组(77例,110155.00元),单纯使用硼替佐米组(59例,233422.57元)高于联合用药组(19例,142197.20元)。与传统化疗组相比,硼替佐米组总体、单纯使用硼替佐米组和联合用药组每增加一个百分点的总有效率(ORR)的成本分别为1889.78元、6522.09元和1130.50元;每增加一个百分点的完全缓解率(CRR)的成本分别为2457.87元、7179.24元和2373.50元。以质量调整生命年(QALY)为效用指标,硼替佐米组相对传统化疗组的增量成本-效用比范围中值为91053.00元/QALY;以3%的贴现率进行成本贴现,增量成本-效用比范围中值为111983.64元/QALY。敏感性分析结果与上述研究结果一致。结论传统化疗方案治疗MM更为经济,但使用硼替佐米能提高治疗效果;经济条件允许时,推荐使用硼替佐米;同时联合用药方案治疗MM比单纯使用硼替佐米方案更具成本-效果。Objective To estimate the cost-effectiveness of bortezomib in the treatment of Multiple Myeloma(MM),and to provide evidence for making decision in the treatment of MM.Methods The treatment cost and clinical efficacy data of 155patients with MM who reached the plateau stage of treatment in two tertiary hospitals in Guangzhou from 2008 to 2013 were collected,and the survival time and utility value of MM patients reported in the literature were retrieved.The cost-effectiveness/utility of bortezomib and traditional chemotherapy in the treatment of MM were estimated,and the sensitivity of the results was analyzed.Results The per capita cost of reaching the plateau in the bortezomib group(78 cases,150218.32 yuan)was higher than that in the traditional chemotherapy group(77 cases,110155.00 yuan),and the bortezomib group alone(59 cases,233422.57 yuan)was higher than the combination drug group(19 cases,142197.20 yuan).Compared with the traditional chemotherapy group,the overall cost of the bortezomib group,the bortezomib-only group and the combination group increasing by one percentage point in the overall effective rate(ORR)were 1889.78 yuan,6522.09 yuan and 1130.50 yuan,respectively;The cost of complete remission rate(CRR)per one percentage point increase was 2457.87 yuan,7179.24 yuan and 2373.50 yuan,respectively.Using quality-adjusted life years(QALY)as the utility index,the median incremental cost-utility ratio range of the bortezomib group relative to the traditional chemotherapy group was 91053.00 yuan/QALY;the cost was discounted at a discount rate of 3%,and the median incremental cost-utility ratio range was 111983.64 yuan/QALY.The results of sensitivity analysis were consistent with those of the above studies.Conclusion Traditional chemotherapy regimens are more economical in the treatment of MM,but the use of bortezomib can improve the therapeutic effect;when economic conditions permit,bortezomib is recommended;at the same time,the combination regimen is more cost-effective than the bortezomib regimen alone.

关 键 词：多发性骨髓瘤 硼替佐米 成本 成本-效果分析 成本-效用分析 

分 类 号：R733.3[医药卫生—肿瘤] R956[医药卫生—临床医学]