曲妥珠单抗辅助治疗人表皮生长因子受体-2阳性早期乳腺癌患者的成本效果分析

发布时间：2018-08-08 20:54

【摘要】：目的评价曲妥珠单抗(赫赛汀)辅助治疗与单纯化疗治疗人表皮生长因子受体-2(HER2)阳性早期乳腺癌的长期成本-效果,为广州市乳腺癌分子靶向治疗患者援助项目(PAP项目)的持续和调整提供依据。方法构建马尔科夫(Markov)模型,建立5种马尔科夫Markov状态,模型的循环周期为1年,模拟两组患者长期生存(45年)获得的质量调整生命年(QALYs)。患者各状态的效用值和疾病转移概率来自曲妥珠单抗临床试验和已经公开发表的文献。从医保部门的角度,本研究仅考虑直接医疗成本。乳腺癌治疗成本源于广州市15家三甲医院的乳腺癌专家的问卷调查,药物及HER2检测成本由Roche制药公司提供,采用3%的贴现率对成本和健康产出进行贴现。对贴现率、药品费用等变量进行单因素敏感性分析。采用蒙特卡洛模拟进行概率敏感性分析,结果用增量成本效果散点图表示。结果无援助项目时,曲妥珠单抗组增加1.79个QALYs,成本增加了53 301元,此时增量成本效果比(ICER)为29 731元/QALY,以2015年广州市人均GDP作为阈值时,具有成本-效果优势;有援助项目时,曲妥珠单抗组增加1.79个QALYs,直接医疗成本降低37 833元,为绝对优势方案。敏感性分析结果显示,在参数的不确定性取值变化范围内,模型具有稳健性,提示本研究结果稳定。结论与单纯化疗相比,曲妥珠单抗辅助治疗具有更好的疗效以及经济性。广州市乳腺癌分子靶向治疗患者援助项目大幅度缓解了乳腺癌患者的疾病经济负担,值得持续和推广。
[Abstract]:Objective to evaluate the long-term cost-effectiveness of tratozumab (Herceptin) adjuvant therapy and chemotherapy alone in the treatment of human epidermal growth factor receptor -2 (HER2) positive early breast cancer. To provide the basis for the continuation and adjustment of the Molecular targeted Therapy for Breast Cancer patient Assistance Project (PAP Project) in Guangzhou. Methods the Markov (Markov) model was constructed and five Markov Markov states were established. The cycle of the model was one year. The QOL (QALYs). Obtained from the long-term survival (45 years) of the two groups of patients was simulated. The utility values and disease metastasis probabilities of each state of the patient were derived from the tratozumab clinical trials and published literature. From the perspective of the health care sector, this study only considers direct medical costs. The cost of breast cancer treatment originates from the questionnaire survey of breast cancer experts in 15 third Class A hospitals in Guangzhou. The cost of drug and HER2 detection is provided by Roche Pharmaceutical Company. The cost and health output are discounted with a discount rate of 3%. The single factor sensitivity analysis was performed on the discount rate, drug cost and other variables. The probability sensitivity analysis is carried out by Monte Carlo simulation, and the result is represented by incremental cost effect scatter plot. Results when there was no assistance project, 1.79 QALYs were increased and the cost was increased by 53,301 yuan in the tratozumab group. The incremental cost effect was 29,731 yuan / QALY compared with (ICER) at this time. The threshold value of GDP per capita in Guangzhou City in 2015 had the advantage of cost-effect advantage. In tratozumab group, 1.79 QALYs were increased, and the direct medical cost was reduced by 37,833 yuan. The results of sensitivity analysis show that the model is robust in the range of parameter uncertainty, indicating that the results of this study are stable. Conclusion compared with chemotherapy alone, trotozumab is more effective and economical in adjuvant treatment. The project of molecular targeted therapy for breast cancer in Guangzhou has greatly alleviated the economic burden of breast cancer patients and is worthy of sustained and popularized.
【作者单位】：暨南大学医学院;河北医科大学第二医院;
【基金】：暨南大学“公共卫生与预防医学”一级学科师资基金(JNUPHPM0301)
【分类号】：R737.9

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