防治化疗相关性恶心呕吐药物的成本-效用分析

Cost-utility Analysis of Drugs for Prevention and Treatment of Chemotherapy-induced Nausea and Vomiting

关键词:  奈妥匹坦  帕洛诺司琼  地塞米松  决策树模型  成本-效用分析  化疗相关性呕吐  止吐

Key words:  netupitant  palonosetron  dexamethasone  decision tree model  cost-utility analysis  chemotherapy-induced nausea and vomiting  antiemetic

摘要:

目的 从中国的社会医疗角度出发，对3种止吐方案阿瑞匹坦+帕洛诺司琼+地塞米松三联方案(APD)、阿瑞匹坦+帕洛诺司琼+地塞米松+奥氮平四联方案(APDO)及奈妥匹坦/帕洛诺司琼胶囊+地塞米松三联方案(NPD)进行成本-效用分析，从而为临床决策提供参考。方法 建立决策树模型，以增量成本-效用比(incremental cost-utility ratio，ICUR)为分析指标，以2020年一倍中国人均国内生产总值72 000元/质量调整生命年(quality-adjusted life year，QALY)作为意愿支付值(willingness-to-pay，WTP)，比较APD、APDO及NPD方案在中国的成本-效用性，并进行一系列敏感性分析以评估模型的稳定性。结果 从中国的社会医疗角度出发，对于接受高度致吐性化疗方案的癌症患者，APDO、NPD方案与APD方案相比的ICURs分别为48 400.97元/QALY、46755.56元/QALY，均小于WTP，因此APDO和NPD方案均具有成本-效用性，且NPD方案的成本-效用性更好。敏感性分析结果显示模型稳健。结论 对于中国接受高度致吐性化疗方案的癌症患者，在APD、APDO和NPD方案中，NPD方案是最具经济性的方案。

Abstract:

OBJECTIVE to provide reference for clinical decision making by cost-utility analysis to conduct on three antiemetic regimens from a Chinese social medical perspective, namely the aprepitant+palonosetron+dexamethasone triple regimen(APD), the aprepitant+palonosetron+dexamethasone+olanzapine quadruple regimen(APDO) and the triple regimen of netupitant/palonosetron capsule+dexamethasonetriple regimens(NPD). METHODS Decision tree model was established with incremental cost-utility ratio(ICUR) as the analysis index and 2020 Chinese gross domestic product per capita ￥72 000/quality-adjusted life year(QALY) was used as willingness-to-pay(WTP) to compare the cost-utility of APD, APDO and NPD regimens in China, a series of sensitivity analyses were conducted to assess the stability of the model. RESULTS From the Chinese social medical perspective, for cancer patients receiving highly emetogenic chemotherapy, compared with APD regimen, APDO and NPD regimen yielded ICURs of ￥48 400.97/QALY and ￥46 755.56/QALY, respectively, which were lower than the WTP, thus APDO and NPD regimens were cost-utility and NPD regimen had better cost-utility. The results of sensitivity analyses showed the model was stable. CONCLUSION Among the APD, APDO and NPD regimens, the NPD regimen is the most economical for cancer patients receiving highly emetogenic chemotherapy in China.