高危Ⅱ期结肠癌不同化疗决策的成本-效用分析  

Cost-effectiveness of different chemotherapy strategies for high-risk stageⅡcolon cancer

作　　者：张霞[1] 尹瑞华 金霞云 郑红娟 徐锡枫 王庆华[1] 傅健飞[1] Xia Zhang;Rui-Hua Yi;Xia-Yun Jin;Hong-Juan Zheng;Xi-Feng Xu;Qing-Hua Wang;Jian-Fei Fu(Department of Medical Oncology,Affiliated Jinhua Hospital,Zhejiang University School of Medicine,Jinhua 321000,Zhejiang Province,China)

机构地区：[1]金华市婺城区金华市中心医院肿瘤内科,浙江省金华市321000

出　　处：《世界华人消化杂志》2023年第17期742-752,共11页World Chinese Journal of Digestology

基　　金：金华市科技局公益性技术应用研究项目,No.2021-4-015.

摘　　要：背景结肠癌的发病率及死亡率逐年上升.对于Ⅱ期结肠癌,目前大部分指南仅建议具有高危因素的患者进行化疗.但是治疗决策往往受到资源限制和成本的影响,因此从药物经济学角度评价化疗的受益情况至关重要.目的评估高危Ⅱ期结肠癌患者化疗的成本-效用.方法应用TreeagePro2011软件建立两个马尔科夫(Markov)模型分别代表化疗期和随访期.以质量调整生命年(quality-adjusted life years,QALYs)衡量健康结果,以增量成本-效用比(incremental cost effectiveness ratio,ICER)为治疗策略经济学效益的评价指标并对结果进行敏感性分析.结果通过建立的无病生存期(disease free survival,DFS)曲线进行生存分析,Ⅱ期结肠癌患者可以从化疗中受益(P<0.0001).亚叶酸/5-氟尿嘧啶/奥沙利铂(folinic acid/5-fluorouracil/oxaliplatin,FOLFOX)方案相比观察组的增量成本为27917.36元,增量效用为1.47 QALY,增量成本效用比为18913.88元/QALY.当WTP=216600元时,Monte Carlo模拟分析表明FOLFOX方案相比于观察组具有成本-效用的概率是100%.结论具有高危因素的Ⅱ期结肠癌患者采用FOLFOX方案化疗具有较好的成本-效用.BACKGROUND The incidence and death rates of colon cancer have been increasing year by year.Currently,most guidelines only recommend chemotherapy for stageⅡcolon cancer patients with high risk factors.However,treatment decisions are often influenced by resource constraints and cost,so it is important to evaluate the benefits of chemotherapy by cost-effectiveness analysis.AIM To evaluate the cost-effectiveness of chemotherapy in patients with high-risk stageⅡcolon cancer.METHODS Two Markov models were established using Treeage Pro 2011 software to represent the chemotherapy period and follow-up period.Health outcomes were measured as quality-adjusted life years(QALYs).The incremental cost-effectiveness ratio(ICER)was used as the evaluation index of the economic benefits of the treatment strategy,and the sensitivity analysis was performed on the results.RESULTS Based on the disease free survival(DFS)curve,patients with stageⅡcolon cancer could benefit from chemotherapy(P<0.0001).Compared with observation alone,the incremental cost of the folinic acid/5-fluorouracil/oxaliplatin(FOLFOX)regimen was 27917.36 yuan,the incremental effectiveness was 1.47 QALYs,and the ICER was 18913.88 yuan/QALY.When willingness-to-pay=216600 yuan,Monte Carlo simulation analysis indicated that the FOLFOX regimen had a cost-effective probability of 100%compared to the observation group.CONCLUSION FOLFOX regimen is a more affordable option in China for patients with high-risk stageⅡcolon cancer.

关 键 词：生存分析 MARKOV模型 成本-效用 结肠癌 敏感性分析 

分 类 号：R735.35[医药卫生—肿瘤]