Dranitsaris G, Leung P, Ciotti R, Ortega A, Spinthouri M, Liaropoulos L, Labianca R, Quadri A
Department of Pharmaceutical Services, University Health Network/Princess Margaret Hospital, Toronto, Ontario, Canada.
Pharmacoeconomics. 2001;19(9):955-67. doi: 10.2165/00019053-200119090-00007.
The neurokinin-1 (NK1) receptor antagonists are a new class of agents designed to reduce the risk of emesis following chemotherapy, particularly with cisplatin. Early data from double-blind randomised trials suggest that an orally administered NK1 antagonist can reduce the absolute risk of acute and delayed emesis following cisplatin by 20 and 30%, respectively.
To measure the value that patients with cancer place on improved emesis control and quality of life.
Willingness-to-pay analysis.
Five study sites in Canada, Italy, Spain and Greece.
245 patients with cancer either receiving chemotherapy with cisplatin or who had received cisplatin-based chemotherapy within the previous 6 months.
After background information had been presented, patients were asked to define the maximum that they would pay per day for a drug that reduced their risk of acute and delayed (days 2 to 5) emesis by 20 and 30%, respectively. Costs were converted to US dollars ($US) using year 2000 exchange rates.
For a 20% improvement in acute emesis, Canadian, Italian and Spanish patients with cancer were willing to pay $US46, $US34 and $US63 per day, respectively, compared with $US8 for patients from Greece (p < 0.001). For a 30% improvement in delayed emesis, Canadian, Italian and Spanish patients with cancer were also willing to pay more than their Greek counterparts (SUS41, $US31, $US50 and $US9 daily for 4 days, respectively; p < 0.001). These significant differences in patient value between countries remained, even after adjusting for socioeconomic variables and previous history of emesis.
There are substantial cultural differences in how patients with cancer value benefit and improved quality of life. Since the majority of the world's population resides outside North America and Western Europe, there may be a need to re-evaluate perceived levels of patient benefit and measures of quality of life.
神经激肽-1（NK1）受体拮抗剂是一类新型药物，旨在降低化疗尤其是顺铂化疗后呕吐的风险。双盲随机试验的早期数据表明，口服NK1拮抗剂可分别将顺铂化疗后急性呕吐和延迟性呕吐（第2至5天）的绝对风险降低20%和30%。
评估癌症患者对改善呕吐控制和生活质量的重视程度。
支付意愿分析。
加拿大、意大利、西班牙和希腊的五个研究地点。
245名癌症患者，他们要么正在接受顺铂化疗，要么在过去6个月内接受过含顺铂的化疗。
在介绍背景信息后，要求患者确定他们每天愿意为一种分别将急性呕吐和延迟性呕吐（第2至5天）风险降低20%和30%的药物支付的最高金额。使用2000年汇率将成本换算为美元（$US）。
对于急性呕吐改善20%，加拿大、意大利和西班牙的癌症患者分别愿意每天支付46美元、34美元和63美元，而希腊患者为8美元（p<0.001）。对于延迟性呕吐改善30%，加拿大、意大利和西班牙的癌症患者也比希腊患者愿意支付更多（分别为每天41美元、31美元、50美元和9美元，持续4天；p<0.001）。即使在调整社会经济变量和既往呕吐史后，各国患者价值的这些显著差异仍然存在。
癌症患者对获益和生活质量改善的重视程度存在很大的文化差异。由于世界上大多数人口居住在北美和西欧以外地区，可能需要重新评估患者获益的感知水平和生活质量指标。
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