促红细胞生成素治疗化疗相关性贫血的剂量转换和成本效益：荟萃分析。

Dose conversion and cost effectiveness of erythropoietic therapies in chemotherapy-related anaemia : a meta-analysis.

机构信息

Analysis Group Inc., Boston, Massachusetts, USA.

出版信息

Clin Drug Investig. 2005;25(1):33-48. doi: 10.2165/00044011-200525010-00004.

DOI:10.2165/00044011-200525010-00004

PMID:17523745

Abstract

OBJECTIVE

To estimate a dose-conversion ratio (DCR) between epoetin alfa (EPO) and darbepoetin alfa (DARB) and compare the costs of both drugs at the estimated DCRs using average wholesale prices (AWPs).

METHODS

A search of PUBMED, CANCERLIT and references for papers and abstracts reporting on clinical trials of DARB or EPO for chemotherapy-related anaemia (CRA) identified 56 publications. A meta-analysis was conducted on the 12 eligible papers to estimate a DCR at which the two drugs were equally effective as measured by the area under the curve of haemoglobin (Hb) change (Hb AUC) at weeks 4 and 13. The DCR is based on the ratio of the coefficients of DARB and EPO doses in a regression of Hb AUC on those two variables, baseline Hb, Hb change calculation method, tumour type, and dosing frequency. Studies were frequency-weighted by the number of subjects. DCRs with confidence intervals (CIs) were calculated using a Monte-Carlo approach. Results from the regression were used to calculate DCRs for different dosing regimen comparisons - EPO three times weekly (TIW) versus DARB once weekly (QW), EPO TIW versus DARB once every 2 weeks (Q2W), EPO QW versus DARB QW, and EPO QW versus DARB Q2W. Relative cost effectiveness (RCE) was assessed by comparing drug costs at the estimated DCRs at $US 2003 AWPs [RCE = DCR . ($/U EPO)/($/mug DARB)].

RESULTS

The regression results suggest an EPO QW : DARB QW DCR of 187 (95% CI 183, 191). Depending on the assumed starting dose, the DCR ranges from 126 to 137 for EPO TIW : DARB QW; from 128 to 139 for EPO TIW : DARB Q2W; and equals 191 for EPO QW : DARB Q2W. RCE was 2.0 for the main regression.

CONCLUSION

The DCR of 330 : 1 estimated for the 2004 Hospital Outpatient Prospective Payment System by the Centers for Medicare and Medicaid Services is greater than the DCRs estimated based on Hb AUC. The DCR estimated in the primary regression suggests that based on AWPs, EPO is 2.0 times more cost effective than DARB.

摘要

目的

估算促红细胞生成素（EPO）和达贝泊汀（DARB）之间的剂量转换比（DCR），并使用平均批发价格（AWPs）比较两种药物在估计的 DCR 下的成本。

方法

通过 PUBMED、CANCERLIT 和报告 DARB 或 EPO 治疗化疗相关贫血（CRA）的临床试验的论文和摘要的参考文献进行搜索，确定了 56 篇出版物。对 12 篇合格论文进行荟萃分析，以估算两种药物在第 4 周和第 13 周血红蛋白（Hb）变化曲线下面积（Hb AUC）相等时的 DCR。DCR 基于 DARB 和 EPO 剂量的系数之比，该系数由 Hb AUC 回归于这两个变量、基线 Hb、Hb 变化计算方法、肿瘤类型和给药频率得出。研究通过研究对象的数量进行频率加权。使用蒙特卡罗方法计算置信区间（CI）内的 DCR。从回归中得出的结果用于计算不同给药方案比较的 DCR-EPO 每周三次（TIW）与 DARB 每周一次（QW）、EPO TIW 与 DARB 每两周一次（Q2W）、EPO QW 与 DARB QW 以及 EPO QW 与 DARB Q2W。通过比较估计的 DCR 下的药物成本，以 2003 年美国美元 AWPs 评估相对成本效益（RCE）[RCE = DCR.（美元/UEPO）/（美元/mug DARB）]。

结果

回归结果表明，EPO QW：DARB QW 的 DCR 为 187（95%CI 183，191）。根据假设的起始剂量，EPO TIW：DARB QW 的 DCR 范围为 126 至 137；EPO TIW：DARB Q2W 的 DCR 范围为 128 至 139；EPO QW：DARB Q2W 的 DCR 等于 191。主回归的 RCE 为 2.0。