Schmitz Stephan, Aly Farid, Steinmetz Tilmann, Diehl Volker, Rehwald Ute
Hemato-Oncological Group Practice, University Hospital, Sachsenring 69, 50677 Cologne (Köln), Germany.
Onkologie. 2006 Jun;29(6):258-64. doi: 10.1159/000093312. Epub 2006 Jun 12.
In Germany, patients with relapsed follicular non-Hodgkin's lymphoma do not all receive the same treatment. In this study, 3 therapy regimens were analyzed which were considered to be similar. With the goal of determining the treatment option with the lowest direct costs whilst maintaining the same degree of effectiveness, a cost analysis model was established and applied by way of example to the existing illness constellation.
The German doctors' fee scale (Einheitlicher Bewertungsmassstab, EBM) valid until 2005 served as the basis for the calculation of medical services within the scope of the present statutory health insurance guidelines. A virtual standard patient was constructed for the cost model and treated with the different therapy regimens. The incidences of individual adverse events described in literature served as the basis for the characterization of the average toxicity of the respective treatment methods.
The overall costs result from the sum of the treatment costs and the toxicity-related costs. The effect of additional interventions on the overall cost was also examined.
Whereas the accompanying documentation of costs in clinical studies is organizationally complex and very tedious, the model applied here offers a reliable method of quantifying the costs of the different therapy regimens. It permits the comparison of different treatment alternatives, and it enables, by means of a cost variance analysis, the identification of cost drivers and less expensive measures within a therapy method.
在德国，复发滤泡性非霍奇金淋巴瘤患者并未都接受相同的治疗。在本研究中，分析了3种被认为相似的治疗方案。为了确定在保持相同疗效程度的同时直接成本最低的治疗选择，建立了一个成本分析模型，并以现有疾病情况为例进行应用。
以截至2005年有效的德国医生收费标准（统一评估标准，EBM）作为在现行法定医疗保险指南范围内计算医疗服务费用的基础。为成本模型构建了一个虚拟标准患者，并采用不同治疗方案进行治疗。文献中描述的个体不良事件发生率作为各治疗方法平均毒性特征描述的基础。
总成本由治疗成本和毒性相关成本之和得出。还研究了额外干预对总成本的影响。
虽然临床研究中成本的附带记录在组织上很复杂且非常繁琐，但此处应用的模型提供了一种可靠的方法来量化不同治疗方案的成本。它允许比较不同的治疗选择，并通过成本差异分析，在一种治疗方法内识别成本驱动因素和成本较低的措施。
