基于Markov模型对我国晚期胰腺癌3种化疗方案的药物经济学研究
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篇名: | 基于Markov模型对我国晚期胰腺癌3种化疗方案的药物经济学研究 |
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摘要: | 目的:评价吉西他滨(G)、吉西他滨联合奥沙利铂(GM)、吉西他滨联合替吉奥(GS)3种方案治疗晚期胰腺癌的经济性。方法:本研究从患者角度出发,构建Markov模型,对我国18~75岁晚期胰腺癌患者接受3种化疗方案的长期成本和健康产出进行计算;采用成本-效果分析等方法,结合意愿支付水平(WTP)判断其经济性,并进行敏感性分析。结果:成本-效果分析结果显示,G方案治疗晚期胰腺癌患者成本-效果比(C/E)为145 228.52元/12.26 质量调整生命月(QALMs), GM方案的C/E为154 783.88元/11.39 QALMs, GS方案的C/E为315 485.28元/23.26 QALMs,G方案为优选方案。增量成本-效果(ICER)分析结果显示, GS与G方案的ICER为15 479.64,超过本研究设定的WTP(12 563元);而GM与G方案的ICER为-10 999.89,GM属于绝对劣势的方案。敏感性分析结果表明,G方案vs.GM方案的ICER结果不稳定,受模型中的参数影响较大;而G方案vs.GS方案和GM方案vs.GS方案对比的ICER分析结果均较为稳定。G方案较GS方案更具成本-效果;GM方案虽然较GS方案更具经济性,但是优越性相对不明显。结论:在意愿支付水平内,成本-效果分析结果显示吉西他滨单药治疗为最优方案,但敏感性分析结果尚不能确定哪一种方案为最优方案。 |
ABSTRACT: | OBJECTIVE: To evaluate the economical efficiency of gemcitabine (G), gemcitabine combined with oxaliplatin (GM), gemcitabine combined with S-1 (GS) in the treatment of advanced pancreatic cancer (APC). METHODS: From the perspective of patients, Markov model was constructed to calculate long-term cost and health outcomes of 3 chemotherapy regimens in Chinese APC patients aged 18-75 old. Cost-effectiveness analysis were used to determine the economic level according to willingness-to-pay (WTP). The sensitivity analysis was conducted for cost, effectiveness and other indexes. RESULTS: The results of cost-effectiveness analysis showed that the cost effectiveness ratio (C/E) of G regimen in the treatment of advanced pancreatic cancer was 145 228.52 yuan/12.26 QALMs; C/E of the GM regimen was 154 783.88 yuan/11.39 QALMs; C/E of GS regimen was 315 485.28 yuan/23.26 QALMs; and the G regimen was the best option. The incremental cost-effectiveness (ICER) of GS and G regimen was 15 479.64, exceeded the WTP (12 563 yuan) set in this sutdy, while ICER of GM and G regimen was -10 999.89, and the GM regimen was absolutely inferior. Results of sensitivity analysis showed that ICER of G regimen vs. GM regimen was unstable and influenced greatly by the parameters of the model. Results of ICER analysis of G regimen vs. GS regimen and GM regimen vs. GS regimen kept stable. Compared to GS regimen, G regimen showed cost-effectiveness characteristics and GM regimen showed economic characteristics; the superiority was relatively less obvious. CONCLUSIONS: Within the level of WTP, cost-effectiveness analysis shows that gemcitabine is the optimal solution. However, sensitivity analysis result can not yet determine which scheme is the best one. |
期刊: | 2018年第29卷第6期 |
作者: | 汤少梁,陈文静 |
AUTHORS: | TANG Shaoliang,CHEN Wenjing |
关键字: | 晚期胰腺癌;Markov模型;成本-效果分析;敏感性分析 |
KEYWORDS: | Advanced pancreatic cancer; Markov model; Cost-effectiveness analysis; Sensitivity analysis |
阅读数: | 477 次 |
本月下载数: | 9 次 |
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