Launois R, Reboul-Marty J, Henry B, Bonneterre J
Université de Paris, Faculté de Médecine Léonard de Vinci, Département de Santé Publique et d'Economie de la Santé, Bobigny, France.
Pharmacoeconomics. 1996 Nov;10(5):504-21. doi: 10.2165/00019053-199610050-00008.
The aim of this study was to determine the incremental effectiveness, the incremental health-related quality of life (differences in quality-adjusted progression-free survival between treatments), the incremental cost and the incremental cost-effectiveness and cost-utility ratios, for docetaxel, paclitaxel and vinorelbine, when these drugs were used as second-line treatment in patients with metastatic breast cancer. In the absence of comparative direct evidence of the relative efficacy of docetaxel, paclitaxel and vinorelbine in this setting, a model was designed to determine the effects of the 3 interventions on health outcome and cost. A Markov process model, based on 53 disease states, was thus constructed to evaluate the socioeconomics of the 3 treatment regimens. The model allows assessments from the start of second-line chemotherapy until death. Costs were evaluated from the combined view of the healthcare system and the patient. Direct nonmedical and indirect costs were excluded. Consumption per episode of care was estimated by retrospective analysis of 153 medical reports from 5 different hospitals. Hospital costs were allocated values from the national accounting costs by diagnosis-related group (DRG). The content of the health states was based on the multiattribute health states classification system (MASH). Preference values were assigned by application of a standard reference lottery using 20 oncological nurses as proxies for the patients. The health-related quality-of-life score was used as a quality adjustment weighting factor to calculate quality-adjusted progression-free survival associated with the 3 different regimens. Docetaxel reduces the time spent in progression, decreases the number of complications due to progressive disease and thereby provides better quality of life. It provides a benefit of 57 disease- and discomfort-free days compared with vinorelbine and 22 days compared with paclitaxel. Docetaxel may be thought of as self-financing as a result of savings in hospital admissions, providing net savings of 6800 French francs (FF; 1993 values) compared with expenditure associated with vinorelbine treatment and FF700 compared with the equivalent figures for paclitaxel.
本研究的目的是确定多西他赛、紫杉醇和长春瑞滨在转移性乳腺癌患者二线治疗中的增量疗效、与健康相关的增量生活质量（治疗之间质量调整无进展生存期的差异）、增量成本以及增量成本效果比和成本效用比。由于在这种情况下缺乏多西他赛、紫杉醇和长春瑞滨相对疗效的比较直接证据，设计了一个模型来确定这三种干预措施对健康结局和成本的影响。因此构建了一个基于53种疾病状态的马尔可夫过程模型，以评估这三种治疗方案的社会经济学。该模型允许从二线化疗开始直至死亡进行评估。从医疗保健系统和患者的综合角度评估成本。排除直接非医疗成本和间接成本。通过对来自5家不同医院的153份医疗报告进行回顾性分析，估算每次护理的消耗量。医院成本根据诊断相关组（DRG）从国家核算成本中分配价值。健康状态的内容基于多属性健康状态分类系统（MASH）。使用20名肿瘤护士作为患者的代理人，通过应用标准参考彩票分配偏好值。将与健康相关的生活质量评分用作质量调整加权因子来计算与三种不同方案相关的质量调整无进展生存期。与长春瑞滨相比，多西他赛减少了疾病进展时间，减少了因疾病进展导致的并发症数量，从而提供了更好的生活质量。与长春瑞滨相比，多西他赛可带来57天无疾病和不适的益处，与紫杉醇相比为22天。由于住院次数的节省，多西他赛可被视为自筹资金，与长春瑞滨治疗相关的支出相比净节省6800法国法郎（FF；1993年价值），与紫杉醇的等效数字相比为700 FF。
