贝伐单抗在英格兰和威尔士转移性结直肠癌一线治疗中的成本效益。
The cost-effectiveness of bevacizumab in the first-line treatment of metastatic colorectal cancer in England and Wales.
作者信息
Tappenden P, Jones R, Paisley S, Carroll C
机构信息
School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK.
出版信息
Eur J Cancer. 2007 Nov;43(17):2487-94. doi: 10.1016/j.ejca.2007.08.017. Epub 2007 Oct 1.
BACKGROUND
Bevacizumab is a humanised monoclonal antibody, which has demonstrated significant activity in metastatic colorectal cancer. The aim of this study is to estimate the cost-effectiveness of adding bevacizumab to chemotherapy for patients with untreated metastatic colorectal cancer.
METHODS
A decision-analytic model was developed to estimate the lifetime costs and benefits of adding bevacizumab to irinotecan plus FU/LV (IFL) or 5-FU/LV alone. Effectiveness outcomes, health utilities and resource use data were derived from recent bevacizumab RCTs and from the literature.
RESULTS
Adding bevacizumab to IFL costs approximately pound62,857 per QALY gained. Adding bevacizumab to 5-FU/LV costs approximately pound88,436 per QALY gained. The acquisition cost of bevacizumab is a key determinant of its cost-effectiveness. The probability that bevacizumab has a cost-effectiveness ratio that is better than pound30,000 per QALY gained is close to zero.
CONCLUSIONS
Given high acquisition costs in relation to clinical benefits, bevacizumab is unlikely to represent a cost-effective use of NHS resources.
背景
贝伐单抗是一种人源化单克隆抗体，已在转移性结直肠癌中显示出显著活性。本研究的目的是评估在未经治疗的转移性结直肠癌患者中，将贝伐单抗添加到化疗方案中的成本效益。
方法
建立了一个决策分析模型，以估计将贝伐单抗添加到伊立替康加氟尿嘧啶/亚叶酸钙（IFL）或单独使用5-氟尿嘧啶/亚叶酸钙的终生成本和效益。有效性结果、健康效用和资源使用数据来自近期的贝伐单抗随机对照试验和文献。
结果
在IFL方案中添加贝伐单抗，每获得一个质量调整生命年（QALY）的成本约为62,857英镑。在5-氟尿嘧啶/亚叶酸钙方案中添加贝伐单抗，每获得一个QALY的成本约为88,436英镑。贝伐单抗的购置成本是其成本效益的关键决定因素。贝伐单抗的成本效益比优于每获得一个QALY 30,000英镑的概率接近于零。
结论
鉴于与临床效益相关的高购置成本，贝伐单抗不太可能成为英国国家医疗服务体系（NHS）资源的成本效益型使用方式。
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