培美曲塞对比多西他赛二线治疗非小细胞肺癌的药物经济学研究

Economic Evaluation of Pemetrexed Versus Docetaxel as Second-line Therapy of Patients with Advanced Non-small Cell Lung Cancer

关键词:  培美曲塞  多西他赛  多西紫杉醇  非小细胞肺癌  二线治疗  药物经济学

Key words:  pemetrexed  docetaxel  taxotere  non small cell lung cancer  second-line therapy  pharmacoeconomic evaluation

摘要:

目的 评价培美曲塞与多西他赛单药二线治疗晚期非小细胞肺癌（non small cell lung cancer，NSCLC）的临床疗效及不良反应，并进行药物经济学分析。方法 通过检索数据库，筛选符合条件的培美曲塞、多西他赛单药二线治疗晚期NSCLC的临床试验文献，以疾病控制率及有效率为主要临床疗效指标，统计其不良反应发生率，采用Revman 5.3软件进行meta分析，并建立成本模型，以成本-效果进行分析比较。结果 共检索文献469篇，符合条件7篇，1 372例患者，其中培美曲塞687例，多西他赛685例。培美曲塞与多西他赛有效率[RR=1.22，95% CI（0.89，1.68），P=0.21]和疾病控制率[RR=0.97，95% CI（0.87，1.08），P=0.54]无统计学差异。多西他塞致Ⅲ、Ⅳ度中性粒细胞减少、脱发和神经毒性的不良反应发生率明显高于培美曲塞。用最小成本进行药物经济学分析显示，多西他赛较培美曲塞方案单周期化疗成本可节省13 397.68元。结论 培美曲塞、多西他赛单药二线治疗晚期NSCLC的疗效未见明显差异。培美曲塞不良反应发生率较低，治疗费用较高。对于耐受性好、需要考虑经济因素的患者可将多西他赛方案作为首选，而对于耐受性较差的患者，可根据自身经济条件考虑选择培美曲塞方案。

Abstract:

OBJECTIVE To evaluate and compare the cost-effectiveness of pemetrexed and docetaxel as the second-line chemotherapy for advanced non small cell lung cancer(NSCLC), using an economic analysis. METHODS Search the database then select the qualified randomized phase Ⅲ trials about second-line therapy for advanced non small cell lung cancer, which was treated with pemetrexed and docetaxl. Analyse the cost-effectiveness of these two chemotherapy regimens by comparing the disease control rate, objective response rate. RESULTS Seven out of 469 articles were available, including 1 372 cases of patients, 687 for pemetrexed group and 685 for docetaxel group. There was no significant difference in disease control rate[RR=0.97, 95%CI(0.87, 1.08), P=0.54] and objective response rate[RR=1.22, 95%CI(0.89, 1.68), P=0.21]. Compared with pemetrexed group, docetaxel group had significantly higher rates of Ⅲ and Ⅳ degree of neutrophil decrease, alopecia and neurovirulence. And the cost-effectiveness ratio was lower in the docetaxel group than in the pemetrexed group with the minimum cost of 13 397.68 yuan. CONCLUSION There is no significant difference between pemetrexed and decetaxel in the treatment of advanced NSCLC as a second-line chemotherapy. Pemetrexed chemotherapy has a lower adverse rate, and higher treatment cost. Taking the cost into consideration, the therapy of docetaxel is more optimal then pemetrexed for advanced NSCLC.