rhTPO与IL-11治疗化疗相关血小板减少症的成本效果分析

Cost-effectiveness Analysis of rhTPO and Interleukin-11 in the Treatment of Chemotherapy-related Thrombocytopenia

关键词:  重组人血小板生成素  白介素-11  化疗  成本-效果分析  血小板减少症

Key words:  recombinant human thrombopoietin  interleukin-11  chemotherapy  cost-effectiveness analysis  thrombocytopenia

摘要:

目的 评价重组人血小板生成素（recombinanthuman thrombopoietin，rhTPO）和白介素-11（interleukin-11，IL-11）用于肿瘤患者化疗中出现的血小板减少症的治疗效果和经济性，为决策者在临床药物的选择上提供依据。方法 收集福建医科大学附属第一医院2017年5月28日—2018年2月28日由于化疗所致血小板减少症的病例，分为rhTPO组和IL-11组，通过倾向性评分匹配法按1︰1进行匹配，每组匹配84例；根据血小板下降水平分为2组，为Ⅰ/Ⅱ度、Ⅲ/V度血小板减少组。以显效率和有效率作为疗效评价指标，并根据药物治疗效果采用最小成本分析与成本-效果法评价2种药物治疗不同程度血小板减少症的经济性。结果 对于Ⅰ/Ⅱ度血小板减少症患者，rhTPO组和IL-11组的显效率、有效率以及血小板恢复速度均无统计学差异，利用最小成本法可得，IL-11组所花费成本较rhTPO少。对于Ⅲ/Ⅳ度血小板减少症患者，rhTPO的显效率高于IL-11，2种药物的有效率和血小板恢复速度无统计学差异。采用成本-效果分析可得，在Ⅲ/Ⅳ度血小板减少症时，每获得1%的有效率，需多支出132.24元，远远低于意愿支付阈值（2种药物平均总成本为2 439.43元），提示使用rhTPO的成本-效果性更佳。结论 治疗Ⅰ/Ⅱ度血小板减少症，IL-11的疗效与rhTPO相当，在经济性上更具优势。而对于Ⅲ/Ⅳ度血小板减少症患者，rhTPO的成本-效果性更好。

Abstract:

OBJECTIVE To compare the efficacy and economics of recombinant human thrombopoietin(rhTPO) and interleukin-11(IL-11) in the treatment of thrombocytopenia in cancer patients. To provide an economic basis for decision makers in the selection and application of drugs. METHODS To collect cases of thrombocytopenia due to chemotherapy from 2017.5.28 to 2018.2.28 in the First Affiliated Hospital of Fujian Medical University. The patients were divided into two groups according to the difference between injections of rhTPO and IL-11. The 1︰1 matching method was applied to the propensity value matching method to compare the curative effect, boths groups were matched 84 cases. According to the base-line level of the thrombocytopenia, patients were further divided into Ⅰ/Ⅱ and Ⅲ/Ⅴ degree group. The efficiency rates and overall efficiency rates were evaluated as major treatment outcomes. Minimum-cost analysis and the cost-effectiveness analysis were used to evaluated the economic significance of two groups. RESULTS After comparison, it was found that the efficiency rates, overall efficiency rates and platelet recovery rate had no difference in Ⅰ/Ⅱ groups treated with rhTPO and IL-11. The result of cost-minimization analysis showed that IL-11 had a lower expenditure. For Ⅲ/Ⅳ groups, the efficiency rates of rhTPO were higher than those of IL-11, and there was no difference in overall efficiency rates and platelet recovery rates. The result of cost-effectiveness analysis showed that the incremental cost effectiveness ratio was 132.24 yuan per effective rate, which was lower than willing-to-pay(average cost of two drugs was 2 439.43 yuan). It was suggested that the cost-effectiveness of rhTPO was better. CONCLUSION In the treatment of Ⅰ/Ⅱ thrombocytopenia, the efficacy of IL-11 is comparable to that of rhTPO, which is more economical. For Ⅲ/Ⅳ thrombocytopenia patients, the cost-effectiveness of rhTPO is better.